全脑放疗同步瘤床推量治疗肺癌脑转移瘤临床疗效及预后分析

何君; 张成大; 贾霖; 韩建军; 高飞; 王允; 贾利; 贾冬; 陈艳

doi:10.3971/j.issn.1000-8578.2018.17.1223

全脑放疗同步瘤床推量治疗肺癌脑转移瘤临床疗效及预后分析

Whole Brain Radiotherapy Combined with Simultaneous Integrated Boost for Brain Metastases of Lung Cancer: Its Clinical Effectiveness and Prognosis

摘要

摘要:
目的比较合并1~4个脑转移灶的肺癌患者采用图像引导适形调强放射治疗（image-guided intensity-modulated radiotherapy, IG-IMRT）技术行全脑放疗（wholebrain radiotherapy, WBRT）同步瘤床推量及序贯瘤床推量治疗的近期临床疗效及安全性，探讨肺癌脑转移患者最佳放疗方案。
方法回顾性分析绵阳市第三人民医院2014年5月至2017年5月确诊为肺癌脑转移患者共98例，选取接受WBRT+同步瘤床推量放疗的49例患者为观察组，另选取同时接受WBRT后序贯瘤床推量放疗的49例患者为对照组，比较两组患者的临床疗效及安全性。两组患者均采用IG-IMRT，治疗过程中每天行锥形束CT（cone beam CT, CBCT）校对摆位误差。
结果观察组的放疗总有效率、肿瘤局部控制率和1年生存率分别为87.80%（43/49）、95.92%（47/49）、65.31%（32/49）高于对照组的61.20%（30/49）、81.60%（40/49）、44.90%（22/49），差异有统计学意义（均P < 0.05），中位生存期观察组（15月）高于对照组（12月）。安全性评价：无3、4级急性及晚期不良反应，主要不良反应为脱发、恶心、呕吐、认知功能障碍、记忆力损伤。
结论图像引导下适形调强全脑放疗同步瘤床推量可能是临床治疗肺癌脑转移瘤一种安全、有效的治疗方式。

Abstract:
Objective To investigate the shorter-term curative efficacy and safety of whole brain radio therapy(WBRT) combined with simultaneous integrated boost versus sequential integrated boost using image-guided intensity-modulated radiotherapy (IG-IMRT) for lung cancer patients with 1-4 brain metastases, and to confirm the optimal treatment scheme of lung cancer patients with brain metastases.
Methods We analyzed retrospectively the data of 98 patients diagnosed as brain metastases from lung cancer and admitted in our hospital from May 2014 to May 2017. The patients were divided into two groups: WBRT combined with simultaneous integrated boost (observation group, n=49) or WBRT combined with sequential integrated boost (control group, n=49) using image-guided intensity-modulated radiotherapy to compare the curative efficacy and safety. In the process of treatment, cone-beam CT(CBCT) was used to correct the position.
Results The total effective rate, local control rate and 1-year survival rate in the observation group were higher than those in the control group(87.80%(43/49) vs. 61.20%(30/49), 95.92%(47/49) vs. 81.60% (40/49), 65.31% (32/49) vs. 44.90% (22/49) (all P < 0.05). Median survival time in the observation group was higher than that in the control group(15 vs. 12 months). In addition, no 3-4 grades acute or late toxicities occurred. The main adverse effects included alopecia, nausea, vomiting, cognitive impairment and memory injury.
Conclusion Wholebrain radiotherapy combined with simultaneous integrated boost using image-guided intensity-modulated radiotherapy is a safe and effective treatment for the lung cancer patients with brain metastases.

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