伽玛刀治疗肺癌脑转移瘤疗效分析  

Treatment of Gamma-knife radiosurgery for brain metastasis from lung cancer

作　　者：周文静[1] 胡泽勇[1] 夏廷毅[1] 张纪[2] 匡山[1] 刘晓丽[1] 王丽丽[1] 孙宗权[1] 

机构地区：[1]空军总医院放疗科伽玛刀中心,北京100036 [2]解放军总医院神经外科

出　　处：《立体定向和功能性神经外科杂志》2003年第3期149-150,169,共3页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的　探讨伽玛刀对肺癌脑转移瘤治疗后肿瘤局部控制情况及病人生存期。方法　回顾旋转式伽玛刀治疗的 37例原发肺癌的脑转移瘤 ,颅内单个转移灶 14例 ,多发转移灶 2 3例。其中 15例在术前或术后接受了全脑放疗。患者术前通过肺部活检明确病理 ,其中小细胞癌 11例 ,鳞癌 10例 ,腺癌 13例 ,鳞腺混合癌 3例。随访内容包括影像学检查肿瘤变化的情况 ,生存质量评分 (KPS) ,伽玛刀治疗后生存时间及死亡原因。结果　随访 6～2 6个月 ,平均 14个月。仅 2例病人因脑内肿瘤未控制死亡。 6个月生存率腺癌 6 9.2 %(9/ 13)、鳞癌 6 0 %(6 / 10 )、小细胞癌 6 3.6 %(7/ 11) ;12个月生存率腺癌 38.5 %(5 / 13)、鳞癌 2 0 %(2 / 10 )、小细胞癌 2 7.3%(3/ 11)。肿瘤局部控制率腺癌 87.9%;鳞癌 94.1%;小细胞癌 10 0 %;鳞腺混合癌 94.7%。结论　伽玛刀治疗原发肺癌的脑转移瘤安全有效 ,肿瘤局部控制率高 ,能改善病人的生活质量。Objective To evaluate the survival and local control of brain metastases from lung cancer after Gamma-knife radiosurgery.Methods We treated 70 patients with brain metastases from lung cancer by Rotation Gamma Knife Instrument between Jul.2000 and Mar.2002,and 37 well-document cases.The histological subtypes were as follows: 13 patients (71 lesions) adenocarcinoma,10 patients(32 lesions) squamous cell carcinoma,11 patients(26 lesions) small-cell carcinoma,3 patients (19 lesions) adenosquamous carcinoma.The median tumor volume was 9.72cm 3 (range 0.01-32.09cm 3) and the average prescription dose was 17Gy to the 50% isodose.15 cases received whole brain radiotherapy.The follow-up included MRI scan,Karnofsky Performance Scale(KPS) score,reason of death.Results All the patients were followed up for 6-26 months (median 14 months).Median survival time was 8 months and the number of deaths due to local treatment failure was only 2(8%) out of the total 25 deaths which occurred. Six-month and 1-year survival rates were adenocarcinoma 69.2% and 38.5%,squamous-cell 63.6% and 27.3%.Local control rates were adenocarcinoma 87.9%,squamous-cell 94.1%,small-cell 100%,adenosquamous 94.7%.Conclusions Gamma Knife radiosurgery can effective in local control for brain metastases from lung cancer.

关 键 词：伽玛刀 放射治疗 肺癌 脑转移瘤 疗效 影像学检查 生活质量 

分 类 号：R739.41[医药卫生—肿瘤] R730.55[医药卫生—临床医学]