87例非小细胞肺癌脑转移三维适形放疗疗效分析

目的:探讨非小细胞肺癌脑转移三维适形放疗联合全脑照射的疗效及预后因素.方法:回顾性分析1997年12月至2003年12月在本院行三维适形放疗的87例非小细胞肺癌脑转移患者的临床资料,所有病例先行全脑照射,然后缩野至局部病灶行三维适形低分割推量照射.用Kaplan-meier法分析局部控制率及生存率,预后多因素分析用COX比例风险模型.结果:中位生存时间为14个月,12个月、24个月生存率分别为53%、20%;6个月、12个月局部控制率分别为99%、93%.多因素分析提示颅脑外活动性病灶(P=0.006)、脑转移灶数量(P=0.035)、转移间隔时间(P=0.040)是独立的生存预后因素.结论:三维适形放疗联合全脑照射可有效控制非小细胞肺癌脑转移灶,不良反应可耐受.

A Clinical Study of Three-dimensional Conformal Radiotherapy for Brain Metastases from Non-small Cell Lung Carcinoma-An analysis of 87 cases

Objective: To examine the efficacy of Three-dimensional conformal radiotherapy plus whole brain irradiation for treatment on brain metastases from non-small cell lung carcinoma and to evaluate factors affecting the survivals. Methods: The data of 87 patients during Dec 1997 to Dec 2004 were retrospectively reviewed. All were treated with three-dimensional conformal radiotherapy plus upfront whole brain irradiation for brain metastases from non-small cell lung carcinoma. Kaplan-Meier method was used to analyze the survival rate and local control rate, multivariate analysis was performed to determine significant prognostic factors influencing the survivals using the Cox regression proportional hazards model. Results: The overall median actuarial survival was 14 months from the diagnosis of brain metastases. The actuarial survival rate for 12 and 24 months was 53% and 20% respectively. The actuarial local control rate for 6 months and 12 months was 99% and 93% respectively. In multivariate analyses, factors significantly affecting the local control included those as follows: active extracranial disease (P=0.006), brain metastasis numbers(P=0.035) and time from lung cancer diagnosis to the development of brain metastasis (P=0.040). Conclusion: Three-dimensional conformal radiotherapy plus upfront whole brain irradiation provide an effective tool for brain metastases from non-small cell lung carcinoma with tolerable toxicity.