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目的比较预防性全脑照射或预防性化疗在小细胞肺癌脑转移方面的作用及预后。方法回顾分析1984年6月—1998年6月24例小细胞肺癌根治术后接受脑预防照射的患者。术后病理分期Ⅰ,Ⅱ,ⅢA分别为5,10,9例。预防性全脑照射采用60Co-r线或8MV-X线双侧野对穿照射,常规分割,5次/周,2Gy/次,中平面剂量为30~40Gy/3~4周。同期根治术后预防性化疗30例作对照。结果脑照射组单独首发脑转移率及总的脑转移率分别为4.2%和12.5%,均明显低于预化组的30.0%和43.3%(χ2=4.309,P=0.038;χ2=4.691,P=0.030),二组比较差异均有统计学意义。脑照射组1,3,5年生存率分别为79.2%、54.2%、45.8%;而预化组分别为76.7%、43.3%、33.3%(χ2=1.04,P=0.308),二组比较差异无统计学意义。预防性全脑照射未出现明显的脑损伤后遗症。结论小细胞肺癌根治术后在减少脑转移发生方面预防性全脑照射优于预防性化疗,有提高生存率趋势。
Objective To compare the effect and prognosis of prophylactic whole brain irradiation or prophylactic chemotherapy in brain metastases of small cell lung cancer. Methods From June 1984 to June 1998, 24 patients with small cell lung cancer who underwent radical prophylaxis after brain irradiation were retrospectively analyzed. Postoperative pathological staging Ⅰ, Ⅱ, Ⅲ A were 5,10,9 cases. Preventive whole brain irradiation with 60Co-r line or 8MV-X line on both sides of the wild on the piercing, routine division, 5 times / week, 2Gy / times, the median dose of 30 ~ 40Gy / 3 ~ 4 weeks. In the same period, 30 patients underwent radical preventive chemotherapy as control. Results The rates of brain metastases and brain metastases were 4.2% and 12.5% respectively in the brain irradiation group, which were significantly lower than those in the preconditioning group (30.0% vs 43.3%, χ2 = 4.309, P = 0.038; χ2 = 4.691, P = 0.030), the difference between the two groups was statistically significant. The 1, 3, 5-year survival rates in brain irradiation group were 79.2%, 54.2% and 45.8% respectively, while those in preconditioning group were 76.7%, 43.3% and 33.3% respectively (χ2 = 1.04, P = 0.308) No statistical significance. Preventive whole brain irradiation did not show significant brain damage sequelae. Conclusion Prophylactic whole-brain irradiation is superior to prophylactic chemotherapy in reducing the incidence of brain metastases after radical operation of small cell lung cancer, with the trend of increasing survival rate.