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目的探讨全脑放射治疗(WBRT)分别联合调强适形放射治疗(IMRT)与联合立体定向放射治疗(SRT)对非小细胞肺癌(NSCLC)1~3个脑转移瘤病灶疗效的比较。方法将2010年1月至2011年12月收治的非小细胞肺癌脑转移患者80例,随机分为WBRT加IMRT组(38例)和WBRT加SRT组(42例),以中位生存时间、局部控制率、1年生存率和周围器官受量等作为评价指标,对两种方法进行疗效与组织损伤的评价和比较。结果 WBRT加IMRT组和WBRT加SRT组的中位生存时间分别为10.6月和11.9月(P=0.144);局部率控制分别为73.7%和90.5%(P=0.002);1年生存率分别为68.4%和81.0%(P=0.070);单个转移灶者1年生存率分别为78.6%和90.0%,2~3个脑转移灶者分别为37.5%和55.6%,两种治疗方法差异无统计学意义(P=0.226);脑干最大受量(D max)分别为(275±285)Gy和(17±25)Gy,平均受量(D mean)分别为(144±152)Gy和(9±14)Gy,差异均有统计学意义(均P=0.000)。结论全脑放射治疗后行立体定向放射治疗局部加量能更好地提高病人的局部控制率,对周围组织损伤更小。
Objective To investigate the efficacy of whole brain radiation therapy (WBRT) in combination with intensity modulated radiotherapy (IMRT) and combined stereotactic radiosurgery (SRT) in the treatment of 1 to 3 brain metastases in non-small cell lung cancer (NSCLC). Methods Eighty patients with brain metastases from January 2010 to December 2011 were randomly divided into WBRT plus IMRT group (n = 38) and WBRT plus SRT group (n = 42). The median survival time, Local control rate, 1-year survival rate and the amount of surrounding organs as the evaluation index, the two methods for the evaluation of efficacy and tissue damage and comparison. Results The median survival time of WBRT plus IMRT group and WBRT plus SRT group was 10.6 months and 11.9 months respectively (P = 0.144). The local control rate was 73.7% and 90.5% (P = 0.002) respectively. The 1-year survival rates were 68.4% and 81.0%, respectively (P = 0.070). The 1-year survival rates of single metastasis were 78.6% and 90.0% respectively, while those of 2 ~ 3 brain metastases were 37.5% and 55.6% respectively. There was no statistical difference between the two treatment methods (P = 0.226). The maximum amount of brain stem (D max) was (275 ± 285) Gy and (17 ± 25) Gy respectively, and the mean values were (144 ± 152) Gy and 9 ± 14) Gy, the differences were statistically significant (P = 0.000). Conclusion Whole brain radiation therapy stereotactic radiation therapy local dosage can better improve the local control rate of patients, less damage to the surrounding tissue.