CAJ | 학술논문

目的总结立体定向放疗(SRT)加或不加全脑放疗(WBRT)治疗多发脑转移瘤的结果,探讨WBRT和SRT在多发脑转移瘤治疗中的作用.方法 1995-2010年收治的98例新诊断的多发(2～13个病灶)脑转移瘤患者.单纯SRT44例,WBRT加SRT 54例.剂量分割模式依据转移瘤部位、体积及是否WBRT.用Kaplan-Meier法计算生存率,Cox回归模型进行各因素预后分析.中位生存期(MST)为从脑转移瘤放疗开始至各种原因所致死亡的时间的中位数.结果全组患者中位随访时间12个月,随访率为100％.全组MST为13.5个月,其中SRT组、WBRT加SRT组的分别为13.0、13.5个月(x2=0.31,P=0.578).多因素分析显示仅卡氏评分(x2=6.25,P=0.012)、原发灶诊断及脑转移瘤诊断间隔时间(x2=7.34,P=0.025)和颅外病变情况(x2=4.20,P=0.040)是预后因素.结论 SRT是多发脑转移瘤患者有效治疗手段,单纯SRT可取得与WBRT加SRT相似的生存期.首程SRT可能是多发脑转移瘤患者的另一治疗选择.
목적 총결입체정향방료(SRT)가혹불가전뇌방료(WBRT)치료다발뇌전이류적결과,탐토WBRT화SRT재다발뇌전이류치료중적작용.방법 1995-2010년수치적98례신진단적다발(2～13개병조)뇌전이류환자.단순SRT44례,WBRT가SRT 54례.제량분할모식의거전이류부위、체적급시부WBRT.용Kaplan-Meier법계산생존솔,Cox회귀모형진행각인소예후분석.중위생존기(MST)위종뇌전이류방료개시지각충원인소치사망적시간적중위수.결과 전조환자중위수방시간12개월,수방솔위100％.전조MST위13.5개월,기중SRT조、WBRT가SRT조적분별위13.0、13.5개월(x2=0.31,P=0.578).다인소분석현시부잡씨평분(x2=6.25,P=0.012)、원발조진단급뇌전이류진단간격시간(x2=7.34,P=0.025)화로외병변정황(x2=4.20,P=0.040)시예후인소.결론 SRT시다발뇌전이류환자유효치료수단,단순SRT가취득여WBRT가SRT상사적생존기.수정SRT가능시다발뇌전이류환자적령일치료선택.
Objective To summarize the results of stereotactic radiation therapy (SRT) with or without whole-brain radiotherapy (WBRT) in the treatment of multiple brain metastasis.Methods From May 1995 to April 2010,totally 98 newly diagnosed multiple (2 - 13 lesions) brain metastases patients were treated in our centre.Forty-four patients were treated with SRT alone and 54 with SRT + WBRT.Dose fractionation schemes were 15 -26 Gy in 1 fraction or 24.0 -52.5 Gy in 2 - 15 fractions with 3.5 - 12.0 Gy per fraction,depending on the tumor volume,location,and history of prior irradiation.Kaplan-Meier and Cox proportional hazards regression analyses were used for survival analysis.The median age of the whole group was 55 years.The survival time was calculated from the date of radiation treatment to the day of death by any cause.Results The median follow-up time for the whole group was 12 months,and the follow-up rate was 100％.The median overall survival time was 13.5 months for the whole group,there was no difference between SRT alone group and SRT + WBRT group ( 13.0 months vs.13.5 months,χ2 =0.31,P =0.578 ).The Karnofsky Performance Score ( KPS) at the time of treatment ( χ2 =6.25,P =0.012 ),the interval between the diagnosis of the primary tumor and brain metastases ( χ2 =7.34,P =0.025 ) and the status of extracranial metastases ( χ2 =4.20,P =0.040) were independent prognosis factors for survival in multivariate analyses.Conclusions Stereotactic radiation therapy is an effective and alternative treatment choice for multiple brain metastases.