基于直线加速器分次立体定向放射治疗非小细胞肺癌脑转移患者的生存分析  

Efficacy and Safety of Fractionated Stereotactic Radiotherapy with Linear Accelerator for Brain Metastases in Non-Small Cell Lung Cancer Patients

作　　者：王婷婷[1] 郭业松[1] 花蕊 张峻源 李玉红 陈薇[1] 何侠[1] 吴建峰[1] WANG Tingting;GUO Yesong;HUA Rui;ZHANG Junyuan;LI Yuhong;CHEN Wei;HE Xia;WU Jianfeng(Jiangsu Cancer Hospital,Jiangsu Institute of Cancer Research,The Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China)

机构地区：[1]江苏省肿瘤医院,江苏省肿瘤防治研究所,南京医科大学附属肿瘤医院,江苏南京210009

出　　处：《肿瘤学杂志》2025年第3期214-223,共10页Journal of Chinese Oncology

基　　金：国家自然科学基金青年项目(82002869)。

摘　　要：[目的]评估基于直线加速器的分次立体定向放疗(fractionated stereotactic radiotherapy,FSRT)对非小细胞肺癌(non-small cell lung cancer,NSCLC)脑转移患者的疗效及安全性。[方法]回顾性分析了175例接受基于直线加速器FSRT的NSCLC脑转移患者(处方剂量范围为20~60 Gy,照射次数2~15 f),根据α/β比值为10的生物有效剂量(biologically effective dose with an α/β ratio of 10,BED10)分为≤58 Gy组和>58 Gy组。66例患者联合免疫治疗,通过与未联用免疫治疗组的比较探讨FSRT联合免疫治疗的协同作用。采用Kaplan-Meier方法和Log-rank检验分析患者的生存情况并比较不同治疗组间的生存差异。采用Cox比例风险回归模型识别对患者预后具有显著性影响的关键因素。[结果]截至2023年12月,中位颅内无进展生存期(intracranial progression-free survival,iPFS)为11.80个月,中位总生存期(overall survival,OS)尚未达到。多变量Cox分析显示,未控颅外肿瘤显著性降低了iPFS(HR=2.32,95%CI:1.52~3.54)和OS(HR=3.44,95%CI:2.07~5.73)。BED10>58 Gy在不增加中枢神经系统毒性风险(χ^(2)=0.14,P=0.71)的同时显著性提升了iPFS(χ^(2)=4.61,P=0.03)和OS(χ^(2)=4.22,P=0.04),且BED10>58 Gy是i PFS的独立有利预后因素(HR=0.60,95%CI:0.41~0.89)。免疫治疗为OS的独立有利预后因素(HR=0.37,95%CI:0.22~0.63)。FSRT治疗BED10>58 Gy联合免疫治疗显著性改善了iPFS(χ^(2)=4.29,P=0.04)和OS(χ^(2)=5.04,P=0.03)。[结论]基于直线加速器FSRT是治疗NSCLC脑转移瘤患者的安全的有效方法。FSRT治疗BED10>58 Gy、以及FSRT与免疫治疗联合可显著性改善生存情况。[Objective] To evaluate the efficacy and safety of fractionated stereotactic radiotherapy (FSRT)with linear accelerators for non-small cell lung cancer(NSCLC) patients with brain metastasis.[Methods] Aretrospective analysis was conducted on 175 NSCLC patients with brain metastasis treated with FSRT(prescribed doses ranged from 20 to 60 Gy,delivered in 2 to 15 fractions).Patients were divided into≤58 Gy and>58 Gy groups according to the biologically effective dose with an α/β ratio of 10.There were 66 patients receiving combined immunotherapy,and the outcomes were compared between patients with and without immunotherapy.Survival analysis was conducted using the Kaplan-Meier method and Log-rank test,and the prognostic factors were identified using Cox proportional hazards regression models.[Results] Patients with followed up till December 2023,the median intracranial progression-free survival(iPFS) was 11.80 months,and the median overall survival (OS) had not reached.Multivariate Cox analysis indicated that uncontrolled extracranial tumors (HR=2.32,95%CI:1.52~3.54) and OS (HR=3.44,95%CI:2.07~5.73) were independent risk factors for intracranial progression-free survival PFS.BED10>58 Gy significantly improved iPFS (χ~2=4.61,P=0.03) and OS (χ~2=4.22,P=0.04) without increasing the risk of central nervous system (CNS) toxicity (χ~2=0.14,P=0.71).BED10>58 Gy was an independent favorable prognostic factor for iPFS (HR=0.60,95%CI:0.41~0.89).Immunotherapy was an independent favorable prognostic factor for OS (HR=0.37,95%CI:0.22~0.63).BED10>58 Gy combined with immunotherapy significantly improved both i PFS (χ~2=4.29,P=0.04) and OS (χ~2=5.04,P=0.03).[Conclusion] FSRT with linear accelerators is safe and effective for treating NSCLC brain metastases.BED10>58 Gy combination with immunotherapy significantly improves survival outcomes.

关 键 词：脑转移 非小细胞肺癌 直线加速器 分次立体定向放疗 生存 

分 类 号：R734.2[医药卫生—肿瘤]