论文部分内容阅读
目的:探讨脑转移瘤适形放疗的疗效及预后因素。方法:40例脑转移瘤患者均接受了颅脑放射治疗。脑转移瘤数>2个者全脑放疗DT40～46Gy/(20～23)次;≤2个者全脑放疗DT40Gy/20次后,局部三维适形加量至DT54～60Gy/27～30次;孤立脑转移瘤者病灶直接采用三维适形放疗至DT54～60Gy/(27～30)次。其中34例接受了放化疗综合治疗。多因素分析采用Cox比例风险模型。结果:40例患者临床症状缓解率达92.5%(37/40),总有效率(RR)为62.5%(25/40),临床疾病控制率(CBR)达97.5%(39/40)。颅内中位局部控制时间为7.2个月,颅内6个月及1年局部控制率为47.5%、10.0%。中位生存期为10.5个月,6个月、1年及2年生存率为65.0%、25.0%和5.0%。放化疗综合治疗者生存期较单纯放疗者有延长趋势,但差异无统计学意义,P=0.290。Cox多因素分析结果表明,KPS体力评分、颅外原发灶控制情况是脑转移瘤适形放疗疗效的独立预后因素,P<0.05。结论:脑转移瘤患者适形放疗可明显缓解临床症状,提高生活质量,并显著延长生存期。体力状况、颅外原发灶控制情况是脑转移瘤适形放疗疗效的独立预后因素。
Objective: To investigate the efficacy and prognostic factors of conformal radiotherapy for brain metastases. Methods: Forty patients with brain metastases underwent craniocerebral radiation therapy. Brain metastases> 2 whole brain radiotherapy DT40 ~ 46Gy / (20 ~ 23) times; ≤ 2 people after whole brain radiotherapy DT40Gy / 20 times, the local three-dimensional conformal dosage to DT54 ~ 60Gy / 27 ~ 30 times ; Isolated brain metastases were directly treated with three-dimensional conformal radiotherapy to DT54 ~ 60Gy / (27 ~ 30) times. 34 of them received radiotherapy and chemotherapy combined treatment. Multivariate analysis used a Cox proportional hazards model. Results: The remission rate of clinical symptoms in 40 patients was 92.5% (37/40), the total effective rate (RR) was 62.5% (25/40) and the clinical disease control rate (CBR) was 97.5% (39/40). The intracranial median local control was 7.2 months. The intracranial 6 months and 1 year local control rates were 47.5% and 10.0% respectively. The median survival time was 10.5 months, and the 6-month, 1-year and 2-year survival rates were 65.0%, 25.0% and 5.0%, respectively. The overall survival rate of radiotherapy and chemotherapy combined with radiotherapy had an extension trend, but the difference was not statistically significant, P = 0.290. Cox multivariate analysis showed that KPS physical score and control of extracranial primary tumor were independent prognostic factors of CRT efficacy (P <0.05). CONCLUSION: Conformal radiotherapy in patients with brain metastases can significantly relieve clinical symptoms, improve quality of life, and significantly prolong survival. Physical condition, control of extracranial primary lesions is an independent prognostic factor for the efficacy of conformal radiotherapy of brain metastases.