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[目的]探讨肺癌脑转移患者单纯全脑放疗(WBRT)与WBRT+局部X线立体定向放射治疗(X-SRT)的疗效差异。[方法]回顾性分析72例递归分割分析(RPA)2～3级肺癌脑转移患者资料,其中WBRT组36例,WBRT+X-SRT组36例。WBRT组放疗剂量DT30～40Gy/10～20f,WBRT+X-SRT组在WBRT后局部SRT加量DT20～30Gy/2～5f。比较两组生存情况和放射性脑损伤情况。[结果]WBRT组和WBRT+X-SRT组中位生存期分别为7个月和13个月;1年生存率分别为26.6%和54.4%,2年生存率分别为6.6%和31.4%,有统计学差异(χ2=8.555,P=0.003)。WBRT+X-SRT组RPA2级和3级患者的中位生存期均为13个月。WBRT+X-SRT组死于脑内转移者明显少于WBRT组(25.0%vs75.0%,χ2=10.934,P=0.004)。[结论]WBRT+X-SRT治疗能明显提高肺癌脑转移患者的生存率,同时不增加急慢性放射性脑损伤。RPA分级法在肺癌脑转移中可能需进一步完善。
[Objective] To investigate the difference between WBRT and WBRT + local X-ray stereotactic radiotherapy (X-SRT) in patients with brain metastasis of lung cancer. [Methods] The data of 72 patients with brain metastases from grade 2 to grade 3 lung cancer underwent recursive segmental analysis (RPA) were retrospectively analyzed. Among them, 36 patients in WBRT group and 36 patients in WBRT + X-SRT group. Radiotherapy dose of DT30 ~ 40Gy / 10 ~ 20f in WBRT group and DT20 ~ 30Gy / 2 ~ 5f in WBRT + X-SRT group after WBRT. The survival and radiation brain injury were compared between the two groups. [Results] The median survival time of WBRT group and WBRT + X-SRT group was 7 months and 13 months respectively. The 1-year survival rates were 26.6% and 54.4%, respectively. The 2-year survival rates were 6.6% and 31.4% There was a significant difference (χ2 = 8.555, P = 0.003). The median survival of RPA grade 2 and grade 3 patients in the WBRT + X-SRT group was 13 months. WBRT + X-SRT group died of brain metastasis was significantly less than the WBRT group (25.0% vs75.0%, χ2 = 10.934, P = 0.004). [Conclusion] WBRT + X-SRT treatment can significantly improve the survival rate of patients with brain metastases of lung cancer without increasing acute and chronic radioactive brain injury. RPA classification in lung cancer brain metastasis may need further improvement.