论文部分内容阅读
背景与目的:X线立体定向放射治疗(X-ray stereotactic radiotherapy,SRT)是治疗脑转移瘤的有效方法之一,该研究意在评价脑转移瘤患者SRT的疗效以及影响预后的因素。方法:自1999年7月至2004年12月止,78例脑转移瘤患者在本中心接受SRT方式治疗。其中,49例为单发病灶,29例为多发(2～6个)病灶,总病灶数为122个。38个病灶采用SRT单次治疗,中位处方剂量为15Gy(11～24Gy)。84个病灶采用SRT分次(2～6次)治疗,中位处方剂量为24Gy(11～40Gy)。39例SRT联合全脑放疗30～40Gy。无进展生存率(progression-free survival,PFS)和总生存率(overall survival,OS)分析采用Kaplan-Meier法,单因素和多因素分析分别采用log-rank法和Cox模型。结果:中位生存时间12.9(1.7～77.4)个月。1年颅内PFS为87.4%,1和2年OS分别为53.9%和25.8%。单因素分析显示治疗前KPS(karnofsky performance state)≥70、颅外肿瘤获控制和SRT联合全脑放疗的1年OS明显高于KPS<70、颅外肿瘤未控制和单纯SRT,分别为60.7%对29.4%(P=0.002),69.0%对44.9%(P=0.005),和64.1%对43.4%(P=0.03);联合全脑放疗的获益主要表现在颅外肿瘤获控制或脑病灶数≥2个者。多因素分析显示KPS评分和颅外病灶是否控制是影响总生存的独立因素。结论:采用SRT方式治疗脑转移瘤是有效和安全的,对颅外肿瘤获控制或颅内多发病灶者,SRT联合全脑放疗有利于延长患者的生存期。影响总生存的独立预后因素是KPS评分和颅外病灶是否控制。
BACKGROUND & OBJECTIVE: X-ray stereotactic radiotherapy (SRT) is one of the effective methods for the treatment of metastatic brain tumors. The purpose of this study was to evaluate the efficacy of SRT in patients with brain metastases and the factors that influence prognosis. Methods: From July 1999 to December 2004, 78 patients with brain metastases underwent SRT in our center. Among them, 49 cases of single lesions, 29 cases of multiple (2 to 6) lesions, the total number of lesions was 122. Thirty-eight lesions were treated with SRT and the median prescribed dose was 15 Gy (11-24 Gy). Eighty-four lesions were treated with SRT (2 to 6 times) and the median prescribed dose was 24 Gy (11-40 Gy). 39 cases of SRT combined with whole brain radiation 30 ~ 40Gy. Kaplan-Meier method was used to analyze progression-free survival (PFS) and overall survival (OS). Log-rank and Cox models were used for univariate and multivariate analysis respectively. Results: The median survival time was 12.9 (1.7-77.4) months. The 1-year intracranial PFS was 87.4% and the 1-year and 2-year OS was 53.9% and 25.8%, respectively. Univariate analysis showed that the karnofsky performance state≥70, the one-year OS of extracranial tumor control and SRT combined with whole-brain radiotherapy were significantly higher than those of KPS <70, and the uncontrolled and simple SRT of extracranial tumors were 60.7% 29.4% (P = 0.002), 69.0% vs 44.9% (P = 0.005), and 64.1% vs 43.4% (P = 0.03). The benefits of combined whole-brain radiotherapy were mainly manifested in the control of extracranial tumors or brain lesions Number of 2 or more. Multivariate analysis showed that KPS score and extracranial lesions control is an independent factor affecting the overall survival. Conclusion: SRT is effective and safe for the treatment of brain metastases. For patients with extracranial tumors or multiple intracranial lesions, SRT combined with whole brain radiotherapy may prolong the survival of patients. The independent prognostic factors affecting overall survival were whether KPS scores and extracranial lesions were controlled.