CAJ | 학술논문

背景与目的:X线立体定向放射治疗(X-ray stereotactic radiotherapy,SRT)是治疗脑转移瘤的有效方法之一,该研究意在评价脑转移瘤患者SRT的疗效以及影响预后的因素.方法:自1999年7月至2004年12月止,78例脑转移瘤患者在本中心接受SRT方式治疗.其中,49例为单发病灶,29例为多发(2～6个)病灶,总病灶数为122个.38个病灶采用SRT单次治疗,中位处方剂量为15 Gy(11～24 Gy).84个病灶采用SRT分次(2～6次)治疗,中位处方剂量为24 Gy(11～40 Gy).39例SRT联合全脑放疗30～40 Gy.无进展生存率(progression-free survival,PFS)和总生存率(overall survival,OS)分析采用Kaplan-Meier法,单因素和多因素分析分别采用log-rank法和Cox模型.结果:中位生存时间12.9(1.7～77.4)个月.1年颅内PFS为87.4%,1和2年OS分别为53.9%和25.8%.单因素分析显示治疗前KPS(karnofsky performance state)≥70、颅外肿瘤获控制和SRT联合全脑放疗的1年OS明显高于KPS<70、颅外肿瘤未控制和单纯SRT,分别为60.7%对29.4%(P=0.002),69.0%对44.9%(P=0.005),和64.1%对43.4%(P=0.03);联合全脑放疗的获益主要表现在颅外肿瘤获控制或脑病灶数≥2个者.多因素分析显示KPS评分和颅外病灶是否控制是影响总生存的独立因素.结论:采用SRT方式治疗脑转移瘤是有效和安全的,对颅外肿瘤获控制或颅内多发病灶者,SRT联合全脑放疗有利于延长患者的生存期.影响总生存的独立预后因素是KPS评分和颅外病灶是否控制.
배경여목적:X선입체정향방사치료(X-ray stereotactic radiotherapy,SRT)시치료뇌전이류적유효방법지일,해연구의재평개뇌전이류환자SRT적료효이급영향예후적인소.방법:자1999년7월지2004년12월지,78례뇌전이류환자재본중심접수SRT방식치료.기중,49례위단발병조,29례위다발(2～6개)병조,총병조수위122개.38개병조채용SRT단차치료,중위처방제량위15 Gy(11～24 Gy).84개병조채용SRT분차(2～6차)치료,중위처방제량위24 Gy(11～40 Gy).39례SRT연합전뇌방료30～40 Gy.무진전생존솔(progression-free survival,PFS)화총생존솔(overall survival,OS)분석채용Kaplan-Meier법,단인소화다인소분석분별채용log-rank법화Cox모형.결과:중위생존시간12.9(1.7～77.4)개월.1년로내PFS위87.4%,1화2년OS분별위53.9%화25.8%.단인소분석현시치료전KPS(karnofsky performance state)≥70、로외종류획공제화SRT연합전뇌방료적1년OS명현고우KPS<70、로외종류미공제화단순SRT,분별위60.7%대29.4%(P=0.002),69.0%대44.9%(P=0.005),화64.1%대43.4%(P=0.03);연합전뇌방료적획익주요표현재로외종류획공제혹뇌병조수≥2개자.다인소분석현시KPS평분화로외병조시부공제시영향총생존적독립인소.결론:채용SRT방식치료뇌전이류시유효화안전적,대로외종류획공제혹로내다발병조자,SRT연합전뇌방료유리우연장환자적생존기.영향총생존적독립예후인소시KPS평분화로외병조시부공제.
Background and Objective:X-ray stereotactic radiotherapy(SRT) is one of the effective treatments for brain metastases(BM).This study was to evaluate the efficacy of SRT on BM, and investigate prognostic factors. Methods:Between July 1999 and December 2004,a total of 122 intracranial lesions in 78 patients with BM were treated using SRT in our center.Fortynine patients had a solitary lesion and 29 had multiple(2-6)lesions.Themedian SRT dose was 15 Gy(11-24 Gy)in single fraction for 38 lesions,and 24 Gy(11-40 Gy)in 2-6 fractions for 84 lesions.SRT was combinedwith whole brain radiotherapy (WBRT) of 30-40 Gy for 39 patients.Progression-free survival(PFS)and overall survival(OS)were estimated by Kaplan.Meier method. Univariate and multivariate analyses were pedormedby the log-rank test and Cox model, respectively. Results:The mediansurvival time was 12.9 months(1.7-77.4 months).The 1-year intracranialPFS rate was 87.4%.The 1.and 2-year OS rates were 53.9%and 25.8%, respectively. Univariate analysis showed that the 1-year OS rates were significantly higher in the patients with pretreatment KPS of≥ 70,extracranial lesions controlled and SRT combined with WBRT than in those with KPS of<70 (60.7%vs. 29.4%,P=0.002), extracranial lesions uncontrolled (69%MS.44.9%, P=0.005) and SRT alone(64.1%vs.43.4%.P=0.03).The benefit of treating with WBRT in combination was mainly achieved in Patients with extracranial lesions controlled or with more than one intracranial lesion.Multivariate analysis showed that KPS score and status of extracranial Iesions were independent prognostic factors for OS.Conclusions: SRT is an effective and safe modality for BM. SRT combined with WBRT may prolong the survival time for patients with extracranial lesions controlled or multiple intracranial lesions. Independent prognostic factors for OS are KPS score and status of extracranial lesions.