肺癌脑转移瘤立体定向放射治疗疗效与预后影响因素分析
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摘要
目的:探讨立体定向放射治疗肺癌脑转移瘤的疗效及影响肺癌脑转移瘤病人预后的因素。方法:我院2003年8月至2007年12月82例肺癌脑转移患者接受了放射治疗,其中28例行单纯立体定向放射治疗组(SRT),54例行全脑放疗加立体定向放射治疗组(WBRT+SRT)。SRT组,单次靶区处方剂量4Gy-6Gy,总量12Gy-30Gy。WBRT+SRT组,WBRT1.8Gy-2Gy/次,总剂量28Gy-32Gy/14-16次,SRT治疗同前。结果:全组局部控制率为63.5%,中位生存期为10个月,中位局部无进展生存期为8个月;两组的局部控制率分别为54.5%,67.2%,差异有统计学意义(χ2=3.765,P=0.037),SRT+WBRT组的局部控制率较SRT组有提高;两组中位生存期分别为11个月,10个月(χ2=0.00,P=0.985);两组中位局部无进展生存期均为8个月(χ2 =0.11,P=0.740);两组1年生存率分别为42.9%,42.6%(χ2=0.001,P=0.583)。两组的死亡原因构成比差异有显著性(χ2=8.334,P=0.017),SRT组以颅外因素为主,SRT+WBRT组以颅内因素为主。多因素COX模型分析表明影响生存时间的因素是病理类型。结论:立体定向放射治疗是治疗肺癌脑转移的有效治疗方法,结合全脑放疗可以提高患者的局部控制率,但本组病例是否加用全脑放疗对患者的生存时间无明显影响,病理类型是影响患者生存期的最主要因素。
Objective: To evaluate the effects of stereotactic radiotherapeutic models in the treatment of patients with brain metastasis from lung cancer,and to access the prognostic factors that correlated with survival. Methods: From August 2003 to December 2007,82 consecutive patients who presented with brain metastasis from lung cancer in our hospital received radiotherapy, include which 28 cases were stereotactic radiotherapy (SRT) alone,54 cases were stereotactic radiotherapy combined with whole brain radiotherapy(WBRT).In SRT group,the prescription dose ranged from 4Gy to 6Gy per fraction,with total dose 12Gy-30Gy.The dose of WBRT was 28Gy-32Gy in 14 to 16 fractions,1.8Gy-2Gy per fraction. Results: The local control rates in whole group was 63.5%; the median survival and the median of progression free survival(PFS) in whole group was 10 months and 8 months respectively. The local control rates in two groups were 54.5% and 67.2% respectively(χ2=3.765,P=0.037), which was increased in group SRT+WBRT;the median survival were 11, 10 months(χ2=0.00,P=0.985); the median of progression free survival(PFS) were 8 months in both groups(χ2=0.11,P=0.740); one-year survival in both groups were 42.9%,42.6% respectively(χ2=0.001,P=0.583).There were statistical differences in the death cause composing rate between the two groups(χ2=8.334,P=0.017), the extracrania factors played a main part in SRT group;while it was brain ones in SRT+WBRT group.Multivariate analysis showed pathologic type to be independent factor for overall survival. Conclusions: Stereotactic radiotherapy(SRT) was an effective method in the treatment of brain metastasis from lung cancer. Combining whole brain radiotherapy(WBRT) can increase the local control rate, but whether combining whole brain radiotherapy(WBRT) or not does not appear to compromise survival in our cases.Pathologic type was independent predictor for overall survival in brain metastasis.
Objective: To evaluate the effects of stereotactic radiotherapeutic models in the treatment of patients with brain metastasis from lung cancer,and to access the prognostic factors that correlated with survival. Methods: From August 2003 to December 2007,82 consecutive patients who presented with brain metastasis from lung cancer in our hospital received radiotherapy, include which 28 cases were stereotactic radiotherapy (SRT) alone,54 cases were stereotactic radiotherapy combined with whole brain radiotherapy(WBRT).In SRT group,the prescription dose ranged from 4Gy to 6Gy per fraction,with total dose 12Gy-30Gy.The dose of WBRT was 28Gy-32Gy in 14 to 16 fractions,1.8Gy-2Gy per fraction. Results: The local control rates in whole group was 63.5%; the median survival and the median of progression free survival(PFS) in whole group was 10 months and 8 months respectively. The local control rates in two groups were 54.5% and 67.2% respectively(χ2=3.765,P=0.037), which was increased in group SRT+WBRT;the median survival were 11, 10 months(χ2=0.00,P=0.985); the median of progression free survival(PFS) were 8 months in both groups(χ2=0.11,P=0.740); one-year survival in both groups were 42.9%,42.6% respectively(χ2=0.001,P=0.583).There were statistical differences in the death cause composing rate between the two groups(χ2=8.334,P=0.017), the extracrania factors played a main part in SRT group;while it was brain ones in SRT+WBRT group.Multivariate analysis showed pathologic type to be independent factor for overall survival. Conclusions: Stereotactic radiotherapy(SRT) was an effective method in the treatment of brain metastasis from lung cancer. Combining whole brain radiotherapy(WBRT) can increase the local control rate, but whether combining whole brain radiotherapy(WBRT) or not does not appear to compromise survival in our cases.Pathologic type was independent predictor for overall survival in brain metastasis.
引文
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[35] Sanghavi SN,Miranpuri SS,Chappell R,et al.Radiosurgery for patients with brain metastases:a multi-institutional analysis,stratified by the RTOG recursive partitioning analysis method [J].Int J Radiat Oncol Biol Phys,2001,51(2):425-434.
[36]于飞,杨进,聂歆闻.脑转移瘤立体定向放射治疗疗效分析[J],中国微创外科杂志2003:3(10),404-405.
[37] Jawahar A,Willis BK,Smith DR,et al.Gamma Knife Radiosurgery for Brain Metastases: Do Patients Benefit from Adjuvant External-Beam Radiotherapy? An18-Month Comparative Analysis [J].Sterotact Funct Neurosurg 2002; 79: 262–271.
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[41] Kihlstrom L,Karlsson B,Lindquist C.Gamma knife surgery for cerebral metastases implications for survival based on 16 years experience [J].Stereotact Funct Neurosurg,1993,61:45.
[2] Posner JB. Management of brain metastases [J]. Rev Neurol,1992,148:477.
[3] Auchter RM,Lanmond JP,Buatti JM,et al.Amultiinstitutional outcome and prognostic factor analysis of radiosurgery for resectable single brainmetastases[J]. Int J Radio Oncol Biol Phys,1996,35(1):27.
[4]滕彩勋,等.肺癌脑转移98例临床分析[J].实用肿瘤杂志,1994;9(4):278~279.
[5] Ohta Y,Oda M,Sunezuka Y,et al. Results of recent therapy for non-small cell lung cancer,with brain metastasis as the initial relapse[J].Am J Clin Oncol,2002,25(5):476-479.
[6] GasPar L,Scott C,Rotman M,et al.Recursive Partitioning analysis(RPA) of prognostic factors in three Radiation Therapy Oncology Group(RTOG)brain metastases trials [J].Int J Radiat Oncol Biol Phys,1997:37:745-51.
[7] Wong WW,Schild SE,SawerTE,et al.Analysis of outcome in patients reirradiated for brain metastases[J]. Int J Radiat Biol Phys,1996,34:585.
[8] Kondziolka D, Patel A, Lunsford LD, et al. Stereotactic radiotherapy plus whole brain radiotherapy versus radiotherapy alone for patients with mutiple brain metastasis [J]. Int. J Radial Oncol Biol Phys. 1999; 45 (2)∶427-434.
[9] Serizawa T,Ono J,Lichi T,et al.Gamma knife radiosurgery for metastatic brain tumors from lung cancer:a comparison between small cell and non-small cell carcinoma [J].J Neurosurg,2002,97(5):484-488.
[10]肖建平.脑转移瘤.殷蔚伯,谷铣之主编.肿瘤放射治疗学(第三版) [M].北京:中国协和医科大学出版社.2002:1040-1042.
[11]王忠诚主编.神经外科学(第2版) [M].武汉:湖北科学技术出版社.1998:568-570.
[12] Lunsford LD,Alexander E,Leeffler JS.General introduction history of radiosurgery. In Alexander E et al(eds) [J].Stereotactic Radiosurgery. NewYork, McGraw, 1993: 1-2.
[13] Larson D A,Flickinger FC,Loeffler F S.Stereotactic radiosurgery:techniques and results [J].Princ Pract Oncol,1993;7(4):1.
[14] Hansen HH. Textbook of Lung Cancer[M]. London: Martin Dunita,2000; 253-254.
[15] Cappuzzo F.Medical treatment of brain metastases from lung cancer [J].Suppl Tumori,2002,l(4):558-559
[16] Petrovich Z, Yu C, Giannotta SL, et al. Survival and pattern of failure in brain metastasis treated with stereotactic gamma knife radiosurgery [J].J Neurosurg, 2002,97(5 Suppl):499-506.
[17] Simonova G, Liscak R, Novotny JR, et al. Solitary brain metastases treated with the Leksell gamma knife: prognostic factors for patients [J].Radiother Oncol, 2000,57(2):207-213.
[18] Coia LR. The role of radiation therapy in the treatment of brain metastases[J].Int J Radiat Oncol Biol Phys,1992,23:229-238.
[19] Gaspar LE, Scott C, Murray K, et al. Validation of the RTOG recursive partitioning analysis(RPA) classification for brain metastases[J].Int J Radiat Oncol Biol Phys,2000,47(4):1001-1006.
[20] Nieder C, Nestle U, Motaref B, et al. Prognostic factors in brain metastases: should patients be selected for aggressive treatment according to recursive partitioning analysis(RPA) classes? [J] Int J Radiat Oncol Biol Phys, 2000, 46(2):297-302.
[21] Cho KH,Sc M,Hall WA,et al.The role of radiosurgery for multiple brain metastases [J].Neurosurg Focus,2000;9(2):1-7.
[22] Weltman E,Salvajoli JV,Brandt RA,et al.Radiosurgery for brain metastases:a score index for predicting prognosis [J].Int J Radiat Oncol Biol Phys, 2000; 46(5): 1155-1161.
[23] Lagerwaard FJ,Levendag PC,Nowak PJ,et al.Identification of prognostic factors in patients with brain metastases:A review of 1292 patients [J].Int J Radiat Oncol Biol Phys,1999;43(4):795-803.
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