摘要
目的评价三维适形放疗非小细胞肺癌脑转移临床疗效、不良反应以及预后。方法 65例非小细胞肺癌脑转移患者行全脑放疗(whole brain radiotherapy,WBRT)PTVwb40-50Gy/20-25F或WBRT PTVwb40Gy/20F,同步脑转移灶(pGTVs)加量至60Gy/20F或WBRT PTVwb40Gy/20F后pGTVs再补量20Gy/10F。所有病人均每周接受放疗5次。放疗结束1个月后评价疗效、不良反应。结果 65例均完成放疗计划,其中疗效分完全缓解(complete response,CR)4例(6.15%)、部分缓解(partial response,PR)23例(35.38%)、疾病稳定(stable disease,SD)33例(50.77%)、疾病进展(progression of disease,PD)5例(7.69%),总有效率(CR+PR)41.54%,临床获益率(CR+PR+SD)92.31%。1、2年生存率分别为52.31%(34例)、12.31%(8例)。主要不良反应为脑水肿、乏力、脱发、骨髓抑制、听力下降、记忆力轻度减退,Ⅲ-Ⅳ级神经系统不良反应4例(6.15%)。结论三维适形放疗治疗脑转移瘤能延长其生存期,不良反应可耐受。转移灶加量与单纯全脑放疗相比,未明显提高局控率和总生存率。预后评价分级(graded prognostic assessment,GPA)越高,患者生存时间越长;年龄越大、一般状况评分(karnofsky performance scale,KPS)越低、肿瘤脑转移灶数量越多以及颅外转移灶越多,患者生存期越短。
Objective To assess the therapeutic effect and adverse reactions of 3D conformal radiotherapy（3D-CRT） for patients with brain metastasis of non-small cell lung cancer（NSCLC） and their prognosis.Methods Sixty-five patients with brain metastasis of NSCLC included in this study.One month after they underwent whole brain radiotherapy（WBRT）at the dose of 40-50Gy/2025F or 40Gy/20F,followed by 60Gy/20F or 40Gy/20F and then adding 20Gy/10F,5 times a week,the clinical outcome and adverse reactions of WBRT in the patients were assessed.Results Of the 65 patients who underwent 3D-CRT,4（6.15%） had CR,23（35.38%） had PR,33（50.77%） had SD,and 5（7.69%） had PD,with a total response rate of 41.54% and a clinical curative rate（CR＋PR＋SD） of 92.31%.The 1-and 2-year survival rate for the patients was 52.31% and 12.31%,respectively.The main adverse reactions were cerebral edema,acratia,alopecia,bone marrow suppression,impaired hearing and memory,and III-IV nervous system side effect.Conclusion 3D-CRT can prolong the survival time of patients with brain metastasis of NSCLC with tolerable adverse reactions.Boosting 3D-CRT and simple WBRT cannot significantly improve the local control rate of metastasis and overall survival rate of patients.The higher the graded prognostic assessment（GPA） is,the longer the survival time of patients is.The older the patients are,the lower the karnofsky performance scale（KPS） is.The more the number of metastatic foci is,the shorter the survival time of patients is.
出处
《军医进修学院学报》
CAS
2012年第10期1033-1036,共4页
Academic Journal of Pla Postgraduate Medical School
关键词
非小细胞肺癌
脑转移瘤
三维适形放疗
全脑放疗
预后
non-small cell lung cancer
brain metastatic tumors
3D-CRT
whole brain radiotherapy
prognosis
