CAJ | 학술논문

目的分析肺癌脑转移的立体定向放疗(SRT)疗效和预后因素.方法回顾分析行SRT的152例肺癌脑转移病例.单纯SRT组59例,SRT加全脑放疗(WBRT)组40例,WBRT失败后SRT挽救组53例.Logrank法单因素分析,Cox模型多因素分析.结果全组随访率为97.4％.单纯SRT组,SRT加WBRT组和SRT挽救组6个月、1年局部控制率分别为96.0％、93.4％,94.2％、90.8％和81.7％、77.5％(x2=5.39,P=0.068),1、2、5年生存率分别为47.4％、23.7％、8.5％,55.0％、20.0％、0％和41.5％、7.5％、1.9％(x2=4.08,P=0.130).单因素分析显示诊断肺癌到脑转移时间、卡氏评分、肺癌切除、GPA分级、RPA分级、颅外病变是影响生存的因素(x2 =11.97、5.91、15.48、14.48、15.86、17.36,P=0.001、0.015、0.000、0.000、0.000、0.000).多因素分析显示RPA分级、肺癌切除与总生存有关(x2 =21.02、8.18,P=0.000、0.004).全组患者SRT前和后3个月卡氏评分≤70、80、90的比例分别为48.7％、33.6％、17.8％和27.0％、46.7％、26.3％(t=7.16,P=0.000).结论 SRT对肺癌脑转移有较好疗效且单纯SRT、SRT加WBRT和SRT挽救治疗结果相似；RPA分级、肺癌切除是影响生存因素；SRT可改善患者卡氏评分.
목적 분석폐암뇌전이적입체정향방료(SRT)료효화예후인소.방법 회고분석행SRT적152례폐암뇌전이병례.단순SRT조59례,SRT가전뇌방료(WBRT)조40례,WBRT실패후SRT만구조53례.Logrank법단인소분석,Cox모형다인소분석.결과 전조수방솔위97.4％.단순SRT조,SRT가WBRT조화SRT만구조6개월、1년국부공제솔분별위96.0％、93.4％,94.2％、90.8％화81.7％、77.5％(x2=5.39,P=0.068),1、2、5년생존솔분별위47.4％、23.7％、8.5％,55.0％、20.0％、0％화41.5％、7.5％、1.9％(x2=4.08,P=0.130).단인소분석현시진단폐암도뇌전이시간、잡씨평분、폐암절제、GPA분급、RPA분급、로외병변시영향생존적인소(x2 =11.97、5.91、15.48、14.48、15.86、17.36,P=0.001、0.015、0.000、0.000、0.000、0.000).다인소분석현시RPA분급、폐암절제여총생존유관(x2 =21.02、8.18,P=0.000、0.004).전조환자SRT전화후3개월잡씨평분≤70、80、90적비례분별위48.7％、33.6％、17.8％화27.0％、46.7％、26.3％(t=7.16,P=0.000).결론 SRT대폐암뇌전이유교호료효차단순SRT、SRT가WBRT화SRT만구치료결과상사；RPA분급、폐암절제시영향생존인소；SRT가개선환자잡씨평분.
Objective To assess the clinical efficacy and prognostic factors of Stereotactic Radiotherapy ( SRT) for patients with brain metastases ( BM) from lung cancer. Methods From March 1995 to July 2006, 152 consecutive patients with BM from lung cancer were treated by SRT, among them,59 patients received SRT alone, 40 patients received SRT plus whole brain radiotherapy ( SRT + WBRT) ,and 53 patients were salvaged by SRT after WBRT ( salvaged group). Log-rank method was used for univariate analyses. Cox regression model was used for multivariate analyses. Results The follow-up rate was 97. 4％. The half year and 1 year local control rate for SRT alone group, SRT + WBRT group and salvage group were 96. 0％ and 93. 4％ , 94. 2％ and 90. 8％ ,81. 7 ％ and 77. 5％ ( X2 = 5. 39, P = 0. 068)respectively. The 1-,2-,5 year survival rate for SRT alone group, SRT +WBRT group and salvage group were 47. 4％ , 23. 7％ , 8. 5％ ; 55. 0％ , 20. 0％ , 0％ ; 41. 5％ , 7. 5％ , 1. 9％ , respectively. The median overall survival or each group was 11 , 12, 11 months ( X2 = 4. 08 , P = 0130) . The univariate analysis showed that the interval between diagnosis of lung cancer and BM, KPS, thoracic surgery, GPA grade, RPA class, system disease stable were significant prognostic factors ( X2 =11. 97, 5. 91 , 15. 48, 14. 48 , 15. 86,17. 36 , P = 0. 001 , 0. 015 , 0. 000 , 0. 000 , 0. 000 , 0.000) . The　multivariate analysis showed that the RPA class , thoracic surgery were the independent prognostic factors ( X2 = 21. 02 , 8. 18 , P = 0. 000 ,0. 004) . KPS score less than 70, 80 ,90 for all patients before SRT and 3 months later after SRT were 48. 7％ , 33. 6％ ,17. 8％ and 27. 0％ , 46. 7％ , 26. 3％ respectively ( t = 7. 16, P = 0. 000 ) . Conclusions A definitive benefit of SRT in the treatment BM from lung cancer is observed; there is no difference of survival among SRT alone, SRT +WBRT and salvage treatment. SRT can improve the patients' KPS score. Thoracic surgery,RPA class were the independent prognostic factors for patients with BM from lung cancer.