肺癌脑转移252例综合治疗临床分析

目的 探讨肺癌脑转移综合治疗的疗效及预后影响因素。方法 回顾性分析了２５２例脑转移患者不同治疗方法的生存期生存率。结果 转移灶手术切除及Ｘ－刀治疗辐以放疗、化疗的中位生存期及１、２年生存率明显高于单纯放疗与化疗组（Ｐ〈０．００１及Ｐ〈０．０５）,转移灶数目、部位及有无其它颅外转移均显著影响预后,结论 转移灶的手术切除及Ｘ－刀治疗加放疗和化疗是首选治疗方法。     

228例肺癌脑转移综合治疗临床分析

目的探讨肺癌脑转移综合治疗的疗效。方法回顾分析了2002年3月~2004年8月228例肺癌脑转移患者经不同方法治疗后的生存期与生存率。结果转移灶手术切除或-刀治疗辅以化疗的中位生存期及1、2年的生存率明显高于单纯-刀与化疗组(p<0.01),肺癌的病理类型对生存期与生存率无明显影响(p>0.05);单发转移及无颅外转移者生存期(中位生存期分别为9.5和9.5个月)与生存率(1年生存率分别为36%和32%,2年生存率分别为11%和9%)明显高于多发转移及伴颅外血行转移者(p<0.01)。结论转移灶的手术切除或-刀治疗辅以化疗是治疗肺癌脑转移患者理想的方法,转移的数量与部位多少是影响预后的因素。     

肺癌脑转移252例综合治疗临床分析

目的　探讨肺癌脑转移综合治疗的疗效及预后影响因素。方法　回顾性分析了１９９０年１ 月～１９９６ 年１２ 月采用不同方法治疗的２５２ 例肺癌脑转移患者生存期与生存率。结果　转移灶手术切除及γ或 Ｘ刀治疗辅以放疗、化疗以及放疗与化疗联合组的中位生存期及１ 、２ 年生存率明显高于单纯放疗与化疗组（ Ｐ＜ ００１ 及 Ｐ＜ ００５） ,肺癌的病理类型对生存期与生存率无明显影响（ Ｐ＞００５） ;单发转移及无颅外转移者生存期（ 中位生存期分别为８５ 和８５ 个月） 与生存率（１ 年生存率分别为３５ ％ 和２９ ％ ,２ 年生存率分别为１１ ％ 和８ ％ ） 明显高于多发转移及伴颅外血行转移者（ Ｐ＜ ００１） ;高年龄者（ ≥５０ 岁）１ 年生存率（２９ ％ ） 明显高于低年龄组（１５ ％ , Ｐ＜ ００５） 。结论　转移灶的手术切除及γ或 Ｘ刀治疗加放疗和化疗是治疗肺癌脑转移患者的首选方法,转移的数量与部位多少及年龄是影响预后的因素。     

肺癌脑转移116例放疗近期疗效分析

目的　探讨肺癌脑转移放疗疗效。方法　应用钴 6 0外照射治疗机对明确诊断肺癌脑转移患者施行常规放疗。 2 Gy/日 ,5日 /周 ,全颅对穿 4 0 Gy,病灶扣野追加至 6 0 Gy。结果　小细胞和非小细胞肺癌治疗缓解率组分别为 88.9%和 85 %。结论　肺癌发生脑转移后应用放射治疗可控制、缩小病灶 ,减轻症状 ,提高生活质量 ,延长生命。     

晚期肺癌患者预后因素分析

目的探讨影响晚期肺癌患者生存时间的因素。方法回顾性分析该院2001年6月至2010年6月收治的369例晚期肺癌患者的临床资料。采用SPSS16.0统计软件,进行影响生存期的单因素及多因素COX模型回归分析,探讨性别、病理类型、吸烟史、PS评分、原发部位、转移部位、转移灶数目等因素对患者生存期的影响。结果单因素分析显示:性别(P=0.014)、PS评分(P=0.002)、是否发生脑转移(P=0.021)和全身化疗(P=0.01)与患者预后有关;COX多元回归分析显示:PS评分(P=0.001)、是否发生脑转移(P=0.007)和全身化疗(P=0.021)与预后有关,而性别与预后无关(P=0.074)。结论晚期肺癌中体力状况较好且接受全身化疗的非脑转移患者预后较好。     

短程全脑放疗在非小细胞肺癌脑转移病人中的疗效观察

目的探讨非小细胞肺癌脑转移病人的全脑放疗的疗程以及影响其预后的因素。方法分析101例非小细胞肺癌脑转移全脑放疗病人，其中35例接受5天5×4GY的放疗，另外66例接受2周10×3GY或4周20×2GY的放疗，同时观察6个可能影响预后的因素：包括年龄、性别、KPS、脑转移灶数、是否有颅外转移灶、肺癌确诊到全脑放疗时间、递归分割分析级别。结果全脑放疗的疗程与生存率没有相关性，通过单变量分析：（年龄〈60岁：年龄≥60岁，P=0．020）、（KPS≥70：KPS〈70P〈0．001）、肿瘤确诊到接受全脑放疗时间（〉12月：≤12月P=0．007）、有无颅外转移（P〈0．001），提高生存率与这些因素有显著相关性。结论短程的5×4GY更容易被大部分非小细胞肺癌脑转移病人所接受，因为它与长程放疗生存率相似，短程放疗节约治疗时间、节省治疗费用。     

60例肺癌脑转移瘤患者生存与预后分析

目的探讨非小细胞肺癌脑转移不同治疗方案的疗效。方法分析60例肺癌脑转移患者的临床特点。结果单因素分析结果提示原发病治疗方法、脑部放疗方式、T分期、颅外转移数目对患者生存期有影响(P<0.05)。全脑放疗联合全身化疗优于单纯放化疗。Cox模型多因素分析显示脑转移瘤不同治疗方案为独立预后因素(P=0.0001)。结论脑转移瘤不同治疗方案是影响预后的独立预后因素,积极的多学科综合治疗疗效优于单纯全脑放疗。     

非小细胞肺癌脑转移的预后因素分析

目的探讨影响非小细胞肺癌脑转移治疗效果的预后因素。方法收集2006年3月-2009年3月在我科接受全脑放射治疗的57例非小细胞肺癌脑转移患者的临床资料,分析影响生存预后的各种因素。结果平均生存期可达到(9.7±2.8)个月。脑转移放疗后复发再次放疗组生存期(11.5月)优于复发后未放疗组(8.7月),无肺、骨转移组生存期(10.1月)优于有肺、骨转移组(8.5月),有显著统计学差异(P0.05)。多因素分析结果显示:脑转移放疗后复发再次放疗,同步放化疗和无肺、骨转移是肺癌脑转移患者的独立预后因素(P0.05)。结论影响非小细胞肺癌脑转移患者预后的主要因素是有无肺内、骨转移、是否采用同步放化疗,脑转移复发后是否再次放疗,选择同步放化疗以及对于脑转移放疗后复发的患者选择再次放疗的治疗方式,可以延长生存。     

老年腹腔淋巴结转移癌患者97例三维适形放疗的疗效

目的分析三维适形放射治疗老年性腹腔淋巴结转移癌患者的疗效及预后因素分析。方法回顾性分析97例接受三维适形放疗的老年性腹腔淋巴结转移癌患者的临床资料。所有患者中位年龄67岁(60～78岁),原发瘤部位明确,95例(97.9%)原发瘤有病理学证实。腹腔共有转移灶136个,转移灶中位体积35.7 cm3(4.6～123.8 cm3)。腹腔淋巴结转移灶均接受三维适形放疗,中位剂量58 Gy(36～70 Gy)。采用Kaplan-Meier法计算生存率,采用Log-rank法进行单因素分析,采用COX比例风险模型筛选影响预后因素。结果 97例患者治疗后总有效率(CR+PR)84.6%,中位生存期为9个月,1、2、3年生存率分别为37.5%、14.7%、4.8%。单因素分析发现原发瘤部位、病理类型、合并其他部位转移、腹腔淋巴结转移瘤体积、放疗剂量对预后具有明显统计学意义。多因素分析显示腹腔淋巴结转移瘤体积、放疗剂量是影响患者预后的独立因素。结论对于老年性腹腔淋巴结转移癌患者,三维适形放射治疗能有效改善症状、提高生活质量。     

后程三维适形放疗与羟基喜树碱同步化疗治疗小细胞肺癌合并脑转移临床观察

目的探讨后程三维适形放疗（3D—CRT）与羟基喜树碱（HCPT）同步化疗治疗小细胞肺癌（SCLC）合并脑转移患者的临床疗效。方法将117例SCLC脑转移患者随机分为观察组和对照组,两组前程治疗均行普通二维放疗,在全脑照射总剂量（DT）30～40Gy后,后程缩野对脑转移癌局部行3D—CRT,DT50～64Gy。观察组在放疗2～4周后静滴HCPT同步化疗。观察两组疗效及不良反应。结果观察组有效率83．1％,对照组65．5％,两组比较有统计学差异（P〈0．05）;观察组白细胞下降、恶心呕吐的发生率高于对照组,两组1、2a生存率无统计学差异。结论后程3D—CRT联合HCPT同步化疗治疗SCLC脑转移近、远期疗效较好,不良反应轻微,患者能耐受。     

射波刀治疗非小细胞肺癌脑转移近期疗效分析

目的观察射波刀治疗肺癌脑转移的近期疗效。方法收集2011年5月—2013年12月非小细胞肺癌脑转移行射波刀治疗的患者21例,脑转移放射剂量为低分次照射3.50~8.50 Gy/次,1~10次,中位值5次,总剂量5.50~35.00 Gy,中位值24.00 Gy,生物等效剂量15.72~48.00 Gy。结果治疗1个月后,临床症状改善率90.4%;治疗3个月后,临床有效率为71.0%,局部控制率为86.8%。患者治疗3个月后的神经功能损失评分下降、日常生活能力量表评分上升(P均0.05)。结论射波刀治疗肺癌脑转移患者能有效提高其生存率和肿瘤局部控制率,减轻不良反应,改善生活质量,是一种有效的治疗方法。     

大分割放疗联合唑来膦酸治疗肺癌骨转移的临床疗效观察

目的 观察大分割放疗联合唑来膦酸治疗肺癌骨转移的临床疗效及不良反应。方法 90例肺癌骨转移患者随机分成观察组（45例）和对照组（45例）。观察组静滴唑来膦酸4mg加局部大分割放疗30Gy／10f，之后再静滴唑来膦酸4mg×4～6次，1次／月；对照组则单纯放疗，方法剂量同上。结果 观察组止痛总有效率88．8％，显效率60％；对照组总有效率68．8％，显效率26．6％，两组比较P〈0．05。随访3个月后观察组与对照组止痛的总有效率分别为86．6％和57．5％（P〈0．05）。结论 大分割放疗联合唑来膦酸治疗肺癌骨转移，疗效确切，毒副反应轻，耐受性好。     

Distributions in CEA doubling time differ in patients with recurrent colorectal carcinomas

BACKGROUND/AIMS: Serum carcinoembryonic antigen (CEA) is often measured during follow-up of patients surgically treated for colorectal cancer. We determined characteristic findings in serum CEA concentrations or CEA doubling time (DT) depending on the different tumor distributions in colorectal cancer patients. METHODOLOGY: Serum CEA levels were measured monthly until the patients expired in 32 colorectal cancers after operations. CEA DT was based on semilogarithmic plots of time courses of CEA concentrations. RESULTS: In cases who were preoperatively CEA positive, the maximum serum CEA levels for proximal colon, distal colon and rectal cancers were 384.8+/-586.1 ng/mL, 1395.7+/-1954.6 ng/mL and 1343.4+/-1478.3 ng/mL, respectively. The maximum serum CEA level in cases of the proximal colon in preoperative CEA positive patients was lower than that in cases of distal colon or rectum. The average CEA DT on the proximal colon, distal colon and rectal cancers was 71.62+/-43.77 days, 31.07+/-15.98 days and 73.97+/-36.66 days, respectively. The CEA DT with distal colon cancers was also significantly shorter than that with proximal colon or rectal cancers (p<0.05, p<0.02). The CEA DT for lung metastasis was significantly longer than that for liver metastasis, locally or lymph node metastasis or multiple metastases (p<0.02, p<0.02, p<0.001). CONCLUSIONS: CEA DT serves to predict life expectancy for patients with recurrent colorectal cancers with different tumor distributions. We propose that precise measurements of serum CEA are needed so as not to overlook recurrent tumors. Detailed follow-up after operations is necessary for such patients, that CEA DT was noted in case of distal colon cancers.     

Intensity modulated radiation therapy and chemotherapy for locally advanced pancreatic cancer： Results of feasibility study

AIM: To explore whether intensity modulated radiation therapy (IMRT) in combination with chemotherapy could increase radiation dose to gross tumor volume without severe acute radiation related toxicity by decreasing the dose to the surrounding normal tissue in patients with locally advanced pancreatic cancer. METHODS: Twenty-one patients with locally advanced pancreatic cancer were evaluated in this clinical trial. Patients would receive the dose of IMRT from 21Gy to 30Gy in 7 to 10 fractions within two weeks after conventional radiotherapy of 30Gy in 15 fractions over 3 weeks. The total escalation tumor dose would be 51, 54, 57, 60Gy, respectively. 5-fluororacil (5-FU) or gemcitabine was given concurrently with radiotherapy during the treatment course. RESULTS: Sixteen patients who had completed the radiotherapy plan with doses of 51Gy (3 cases), 54Gy (3 cases), 57Gy (3 cases) and 60Gy (7 cases) were included for evaluation. The median levels of CA19-9 prior to and after radiotherapy were 716 U/ml and 255 U/ml respectively (P<0.001) in 13 patients who demonstrated high levels of CA19-9 before radiotherapy. Fourteen patients who suffered from pain could reduce at least 1/3-1/2 amount of analgesic intake and 5 among these patients got complete relief of pain. Ten patients improved in Karnofsky performance status (KPS). The median follow-up period was 8 months and one-year survival rate was 35%. No patient suffered more than grade III acute toxicities induced by radiotherapy. CONCLUSION: Sixty Gy in 25 fractions over 5 weeks with late course IMRT technique combined with concurrent 5-FU chemotherapy can provide a definitely palliative benefit with tolerable acute radiation related toxicity for patients with advanced pancreatic cancer.     

Cho/Cr比值联合NSE对肺癌脑转移/骨转移的预后意义

目的分析Cho/Cr比值联合神经元特异性烯醇化酶(neuron-specific enolase, NSE)对肺癌脑转移/骨转移疗效及预测意义。 方法选择2016年1月至2022年1月我院收治的60例肺癌脑转移和61例骨转移患者,按预后分为单纯组79例和多发转移组42例。治疗结束一周行磁共振MRS检查,计算肿瘤实质区胆碱/肌酸(Cho/Cr)水平,检测患者NSE水平。 结果单纯组Cho/Cr为(23.82±4.12),NSE为(26.95±3.84) ng/ml;多发转移组Cho/Cr为(53.12±6.27),NSE为(35.19±5.02 )ng/ml。单纯组Cho/Cr及NSE水平低于多发转移组(P<0.05);Cho/Cr及NSE与患者预后,OR分别为1.861(95%CI：1.223~2.830)和1.857(95%CI：1.257~2.743),P<0.05;Cho/Cr及NSE联合预测预后质量模型为log(P)＝0.621×Cho/Cr+0.619×NSE+0.592;单独Cho/Cr预测灵敏度,特异度及AUC分别为88.61,83.33和0.872,单独NSE预测灵敏度,特异度及AUC分别为87.34,85.71和0.878,Cho/Cr及NSE联合预测灵敏度,特异度及AUC分别为96.20,95.24和0.957。Cho/Cr及NSE联合应用预测肺癌脑转移/骨转移预后质量的敏感度、特异度及AUC明显高于单独应用指标(P<0.05)。 结论Cho/Cr比值联合NSE与肺癌脑转移/骨转移患者疗效呈正相关,Cho/Cr比值联合NSE预测患者预后具有临床意义。     

Factors affecting the prognosis in patients with primary lung cancer and brain metastases

Brain metastases are frequent features during the course of patients with lung carcinoma. The aim of this study was to investigate prognostic factors for patients with brain metastasis from lung cancer. Eighty-eight patients with brain metastasis from lung cancer were enrolled in the study. Eighty-two of cases were male, six were female and the mean age was 57.5 +/- 10.4 years. The most common symptoms were headache (32.9%) and dizziness (32.9%). Fifty-two (59.1%) patients had solitary brain metastasis and the most frequent metastasing site was parietal lobe (34.1%). The median survival times were 3 months after diagnosis of lung carcinoma and 1.5 months after diagnosis of brain metastasis. Although the absence of brain metastasis at the moment of diagnosis, metachronous metastasis, central localization of the tumour, chemotherapy administration and surgical treatment of brain metastasis are good prognostic factors affecting survival after the diagnosis of lung carcinoma, the positive factors affecting survival after brain metastasis are central localization of tumour, chemotherapy administration and surgical treatment of brain metastasis. In conclusion, performing the combination of cranial radiotherapy, chemotherapy, surgical therapy and supporting therapy should be evaluated in all appropriate patients with brain metastasis from lung cancer.     

肺剂量和炎性细胞因子在预测放疗诱导性肺毒性中的临床价值

目的分析平均肺剂量(MLD)和炎性细胞因子(IL-8和TGF-β1)组合预测放射性肺损伤(radiation-induced lung injury, RILT)的准确性和有效性。 方法选择75例Ⅰ-Ⅲ期的NSCLC患者,通过使用三维适形技术给予放射疗法,在4～7周内每天以2.0～2.9 Gy的剂量递送44～87.9 Gy给患者。分别提取患者放射治疗前(pre),放射治疗2周(2 W),4周(4 W)的血液样品,测定细胞因子的表达含量。患者随访接受病史检查和体格检查以及胸部计算机断层扫描,随访终点为出现RILT症状,或肺炎、肺纤维化等症状。Logistic回归分析平均肺剂量(MLD)和炎性细胞因子(IL-8和TGF-β1)的表达变化以评估其与RILT的相关性,ROC曲线下面积(AUC)用于分析这些因素在预测RILT的特异性和敏感性。 结果75例Ⅰ-Ⅲ期的NSCLC患者中65例出现RILT ,其中16例(24.6%)患者的RILT等级大于2。MLD,基线IL-8水平和TGF-β1 2 W/pre比率的AUC值分别为0.61(0.45,0.77),0.70(0.56,0.84)和0.68(0.53,0.83)。与MLD单独预测相比,MLD,基线IL-8水平和TGF-β1 2w/pre比率组合可将AUC的值从0.61提高到0.73(0.60,0.87)。 结论IL-8和TGF-β1是NSCLC患者RILT的重要预测因子。MLD,IL-8水平和TGF-β1 2 W/pre比率的组合提供了更准确的模型来预测RILT2的风险。     

Patients with brain metastases from gastrointestinal tract cancer treated with whole brain radiation therapy： Prognostic factors and survival

AIM: To identify the prognostic factors with regard to survival for patients with brain metastasis from primary tumors of the gastrointestinal tract. METHODS: Nine hundred and sixteen patients with brain metastases, treated with whole brain radiation therapy (WBRT) between January 1985 and December 2000 at the Department of Radiation Oncology, University Hospital Freiburg, were analyzed retrospectively. RESULTS: Fifty-seven patients presented with a primary tumor of the gastrointestinal tract (esophagus: n=0, stomach: n=10, colorectal: n=47). Twenty-six patients had a solitary brain metastasis, 31 patients presented with multiple brain metastases. Surgical resection was performed in 25 patients. WBRT was applied with daily fractions of 2 Gray (Gy) or 3Gy to a total dose of 50Gy or 30Gy, respectively. The interval between diagnoses of the primary tumors and brain metastases was 22.6mo vs 8.0mo for patients with primary tumors of the colon/rectum vs other primary tumors, respectively (P&lt;0.01, log-rank). Median overall survival for all patients with brain metastases (n=916) was 3.4mo and 3.2mo for patients with gastrointestinal neoplasms. Patients with gastrointestinal primary tumors presented significantly more often with a solitary brain metastasis than patients with other primary tumors (P&lt;0.05, log-rank). In patients with gastrointestinal neoplasms (n=57), the median overall survival was 5.8 mo for patients with solitary brain metastasis vs 2.7mo for patients with multiple brain metastases (P&lt;0.01, log-rank). The median overall survival for patients with a Karnofsky performance status (KPS) ≥70 was 5.5mo vs 2.1mo for patients with KPS &lt;70 (P&lt;0.01, log-rank). At multivariate analysis (Cox Model) the performance status and the number of brain metastases were identified as independent prognostic factors for overall survival. CONCLUSION: Brain metastases occur late in the course of gastrointestinal tumors. Pretherapeutic variables like KPS and the number of brain metastases have a profound influence on treatment outcome.     

后程三维适形放疗联合紫杉醇化疗治疗老年人乳腺癌伴脑转移癌的临床观察

目的 观察后程三维适形放疗(3D-CRT)联合紫杉醇同步化疗治疗老年乳腺癌伴脑转移癌患者的疗效及不良反应.方法 50例患者随机分为观察组(放疗加化疗组,26例)和对照组(单纯放疗组,24例).两组前程全脑均行普通二维放疗,在全脑照射总剂量(DT)30～40 Gy后,后程缩野对脑转移癌局部病灶行3D-CRT,每次2 Gy,每周5次,加量DT 10～24 Gy,至DT 50～64Gy.观察组在放疗2～4周期间给予紫杉醇65～85 mg/m2,静脉滴注第1、8天,同步化疗,然后继续用紫杉醇单药化疗2～4个周期(紫杉醇65～85 mg/m2,第1、8、15天静脉滴注);28 d为1周期,治疗2月后,观察两组近期疗效、不良反应及评价生活质量;随访2年评价客观疗效和生存率.结果 观察组有效率76.9%,高于对照组45.8%,两组比较有统计学差异(x2=5.120,P＜0.05).Karnofsky计分提高+稳定者观察组80.8%、对照组54.2%,观察组生活质量改善高于对照组(x2=4.059,P＜0.05);与对照组相比,观察组白细胞下降,差异有统计学意义;血小板减少、恶心呕吐、肝功能异常等不良反应发生率稍高于对照组,差异无统计学意义.两组2年生存率比较差异有统计学意义(x2=4.7260,P＜0.05).结论 后程3D-CRT联合紫杉醇单药化疗治疗老年乳腺癌伴脑转移癌患者可提高远、近期疗效,不良反应虽有所增加,但患者能耐受,值得临床上进一步推广应用.

Abstract：

Objective To evaluate the efficacy and adverse reaction of three-dimensional conformal radiation therapy (3D-CRT) combined with chemotherapy of paclitaxel in treatment of brain metastases from breast cancer in the elderly.Methods The 50 patients were randomly divided into observation group (n=26,radiation combined with chemotherapy) and control group (n= 24,simple radiation).In the early stage,both groups received common two-dimesional conformal radiation therapy.The total dose (DT) of whole brain irradiation was 30-40 Gy.In the later stage,the reduced field for the local lesion of brain metastases would be altered to 3D-CRT for the post period with 2 Gy 5 times a week.DT was added from 10-24 Gy up to total DT of 50-64 Gy.The patients were given paclitaxel 65-85 mg/m2 by intravenous drip at 1st and 8th day with synchronization of 2-4 weeks,having paclitaxel chemotherapy of 2-4 circle,28 days a circle.After 2 month treatment,the efficacy and adverse effects of the two groups were observed.follow up for 2 years,the long-term efficacy and survival rate were evaluated.Results The effective rate was 76.9% in observation group and 45.8% in control group,respectively (x2 =5.120,P＜0.05) and the KPS score was 80.8% and 54.2%,respectively.The quality of life was improved in observation group versus control group (x2 =4.059,P＜0.05).Compared with control group,hypoleukemia was significant in observation group (P＜0.05).The complications such as nausea and vomiting,hepatic dysfunction were more in observation group than in control group,but there was no statistical significance between two groups.There was statistic ally significant difference in 2-year survival rate between two groups (x2= 4.7260,P＜0.05).Conclusions The 3D-CRT combined with paclitaxel chemotherapy is a prefered choice for locally advanced brain metastases from breast cancer.More side effects and adverse reaction are observed in observation group.However,all the patients could tolerate them.It is worthy of popularization and application.