CAJ | 학술논문

目的分析立体定向放疗结合全脑照射治疗脑转移瘤的疗效和预后,同时观察服用替莫唑胺(TMZ)与放疗结合对患者生存率的影响.方法脑转移瘤患者52例,按照治疗方法不同分为2组,一组为全脑照射(WBRT)+立体定向放疗(SRT,伽玛刀),共35例,一组为单纯SRT,共17例.全脑放疗分次剂量为1.8 ～3.0 Gy/次,1次/d,5次/周,总剂量DT 30 ～40 Gy,WBRT+ SRT组全脑后伽玛刀补量采用45％～ 75％等剂量曲线包绕PTV,边缘剂量12 ～ 15 Gy,中心剂量20～30 Gy.单纯SRT组分次立体定向放疗采用45％～75％等剂量曲线包绕PTV,边缘剂量36 ～ 40 Gy,中心剂量70 ～ 80 Gy.随访1～2年.所选52例患者中有20例患者放疗期间及放疗后服用替莫唑胺胶囊,同步化疗组化疗方案为:口服替莫唑胺75 mg/m2,1次/d,直至放疗结束,放疗结束后再服用3～6个月,剂量改为150 mg/m2.结果放射治疗后1～3个月,复查CT/MRI显示总有效率(CR+PR)为84.62％,WBRT +SRT组有效率为88.57％,SRT组有效率为76.47％；肿瘤的6个月及1年的局部控制率分别为92.10％和85.20％.WBRT+ SRT组的平均生存期13.2个月,中位生存期11个月；6个月生存率为71.40％,12个月生存率为54.30％,18个月生存率为14.30％.SRT组的平均生存期10.2个月,中位生存期9个月；6个月生存率为41.20％,12个月生存率为23.50％,18个月生存率为5.88％.替莫唑胺+放疗与单纯放疗的6个月、12个月及18个月生存率分别为80.00％和56.30％、60.00％和37.50％、10.00％和12.50％.结论 WBRT +SRT治疗脑转移瘤总体上优于单纯SRT治疗.放疗+TMZ联合治疗与单纯放疗相比,替莫唑胺在放疗过程中服用可提高患者生存率,不良反应无显著增加.
목적 분석입체정향방료결합전뇌조사치료뇌전이류적료효화예후,동시관찰복용체막서알(TMZ)여방료결합대환자생존솔적영향.방법 뇌전이류환자52례,안조치료방법불동분위2조,일조위전뇌조사(WBRT)+입체정향방료(SRT,가마도),공35례,일조위단순SRT,공17례.전뇌방료분차제량위1.8 ～3.0 Gy/차,1차/d,5차/주,총제량DT 30 ～40 Gy,WBRT+ SRT조전뇌후가마도보량채용45％～ 75％등제량곡선포요PTV,변연제량12 ～ 15 Gy,중심제량20～30 Gy.단순SRT조분차입체정향방료채용45％～75％등제량곡선포요PTV,변연제량36 ～ 40 Gy,중심제량70 ～ 80 Gy.수방1～2년.소선52례환자중유20례환자방료기간급방료후복용체막서알효낭,동보화료조화료방안위:구복체막서알75 mg/m2,1차/d,직지방료결속,방료결속후재복용3～6개월,제량개위150 mg/m2.결과 방사치료후1～3개월,복사CT/MRI현시총유효솔(CR+PR)위84.62％,WBRT +SRT조유효솔위88.57％,SRT조유효솔위76.47％；종류적6개월급1년적국부공제솔분별위92.10％화85.20％.WBRT+ SRT조적평균생존기13.2개월,중위생존기11개월；6개월생존솔위71.40％,12개월생존솔위54.30％,18개월생존솔위14.30％.SRT조적평균생존기10.2개월,중위생존기9개월；6개월생존솔위41.20％,12개월생존솔위23.50％,18개월생존솔위5.88％.체막서알+방료여단순방료적6개월、12개월급18개월생존솔분별위80.00％화56.30％、60.00％화37.50％、10.00％화12.50％.결론 WBRT +SRT치료뇌전이류총체상우우단순SRT치료.방료+TMZ연합치료여단순방료상비,체막서알재방료과정중복용가제고환자생존솔,불량반응무현저증가.
Objective To analyze the efficacy and prognosis of stereotactic radiotherapy (SRT) and whole-brain radiotherapy (WBRT) in treatment of brain metastases,and to observe the influence of temozolomide (TMZ) on survival rate during the period of radiotherapy.Methods A total of 52 patients with brain metastases were divided into two groups according to treatment methods,including 35 patients treated with WBRT plus SRT and 17 patients treated with SRT alone.WBRT dose was 1.8 - 3.0 Gy per fraction,one fraction a day,five fractions per week,with total dose of 30 - 40 Gy.After WBRT,gamma knife was performed with prescription isodose line of 45％ -70％ surrounding the planned target volume in WBRT + SRT group.The marginal dose was 12 - 15 Gy and the center dose was 20-30 Gy.In SRT group,the prescription isodosc line was 45％ - 70％ and the marginal dose was 36 - 40 Gy while the center up to 70 - 80 Gy.The follow up time was 1 - 2 years.Besides 20 patients in this study took temozolomide capsule during and after radiotherapy.The schedule of concomitant chemotherapy was temozolomide of 75 mg/m2 by oral administration every day until radiotherapy was over,and then temozolomide of 150 mg/m2 was taken for 3 -6 months after radiotherapy.Results The efficiency during 1 -3 months after treatment was 84.62％ in this study.In the WBRT + SRT group,the efficiency was 88.57％ and declined to 76.47％ in the SRT group.The six month-and one year-local control rate were 92.10％ and 85.20％,respectively.The average survival time of WBRT + SRT was 13.2 months and median survival time was 11 months.Six month-,one year-and eighteen months-survival rate were 71.40％,54.30％ and 14.30％,respectively.In the SRT group,the average survival time was 10.2 months and median survival time was 9 months.Six month-,one year- and eighteen month-survival rate were 41.20％,23.50％ and 5.88％,respectively,while those for RT + TMZ group were 80.00％,60.00％ and 10.00％.In comparison,those in RT group were 56.30％,37.50％ and 12.50％,respectively.Conclusions Effect of gamma knife stereotactic radiotherapy combined with WBRT is better than GK stereotactic radiotherapy alone in treatment of brain metastases.Compared with radiotherapy alone,concomitant temozolomide chemotherapy could improve the survival rate of the patients with brain metastases without increasirg adverse reactions significantly.