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目的:分析大分割立体定向放射治疗(HSRT)非小细胞肺癌(NSCLC)脑转移的有效性及预后因素。方法:选取60例有124个脑转移病灶的NSCLC患者进行HSRT,其中90个病变进行全脑放射治疗加HSRT,34个病变初始进行HSRT,中位随访12个月。观察近期疗效及预后因素。结果:全脑放疗加HSRT组46个病变完全缓解(CR),28个部分缓解(PR),9个病变稳定(SD),7个病变进展(PD);6、12个月的局部控制率和总生存率分别为92.3%、66.9%和73.2%、47.6%。单独HSRT组20个病变CR,7个PR,4个SD,3个PD;6、12个月的局部控制率和总生存率分别为92.7%、65.9%和70.2%、45.8%。多因素分析结果显示,脑转移个数(OR=1.675,P=0.001)、颅外有无转移性病灶(OR=1.934,P=0.036)和原发灶控制(OR=7.936,P=0.033)是影响患者生存率的独立预后因素。结论:HSRT是治疗NSCLC脑转移有效方法之一。脑转移个数、颅外有无转移性病灶和原发灶控制是影响患者预后的独立因素。
Objective: To analyze the effectiveness and prognostic factors of brain metastases in large fractionated stereotactic radiotherapy (HSRT) non-small cell lung cancer (NSCLC). Methods: Sixty NSCLC patients with 124 brain metastases were selected for HSRT. 90 of them were treated with whole brain radiotherapy and HSRT. 34 lesions were initially treated with HSRT. The median follow-up was 12 months. To observe the recent efficacy and prognostic factors. Results: In the whole brain radiotherapy plus HSRT group, 46 lesions were completely relieved (CR), 28 partially relieved (PR), 9 lesions were stable (SD) and 7 lesions were progressively developed. The local control rates at 6 and 12 months And overall survival were 92.3%, 66.9% and 73.2%, 47.6% respectively. There were 20 lesions CR, 7 PR, 4 SD and 3 PD in the HSRT alone group. The local control rates and overall survival rates at 6 and 12 months were 92.7%, 65.9% and 70.2%, 45.8%, respectively. Multivariate analysis showed that the number of brain metastases (OR = 1.675, P = 0.001), extracranial metastases (OR = 1.934, P = 0.036) and primary tumor control (OR = 7.936, P = 0.033) Is an independent prognostic factor affecting patient survival. Conclusion: HSRT is one of the effective methods to treat brain metastasis of NSCLC. The number of brain metastases, extracranial metastases and primary tumor control are independent prognostic factors.