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目的 评价姑息性放疗结合化疗治疗肺癌脑转移的疗效及副作用。方法 82例非小细胞肺癌脑转移患者在放疗前及放疗后均接受全身化疗。如为颅内多发转移者 ,给予全颅放疗 ,中平面剂量 33～ 39Gy/11～ 13次 ;如为单个转移者 ,先给予全颅放疗 ,中平面剂量 30Gy/10次 ,后缩野加量15Gy/5次。放疗中同时给予 2 0 %甘露醇及地塞米松脱水治疗。结果 全组 1,2年生存率分别为 46 .7%和 6 .7%。伴有颅外转移组 1,2年的生存率分别为 32 .4%和 4.4% ,仅有颅内转移者生存率为 6 1.2 %和 8.8% ,两组间差异有显著性 (P =0 .0 0 3)。两组的生存率分别为 8个月和 12个月。多因素分析显示 ,原发灶的病理类型、颅内转移灶数与生存率无关。对 5 1例死亡者的调查显示 ,死于全身广泛转移合并多器官衰竭的占 45 .1% (2 3/5 1) ,死于脑转移的占 2 9.4% (15 /5 1) ,死于原发灶的占 2 5 .5 % (13/5 1)。在放疗中及以后的随访中 ,未观察到严重的中枢神经系统并发症。放疗后每月一次的颅脑CT或MR随访中 ,未发现有明显颅内组织损伤的迹象。结论 单纯颅内转移患者较合并颅外转移的生存率有明显提高 ,生存率与原发灶的病理类型、颅内转移灶数无明显相关性。
Objective To evaluate the efficacy and side effects of palliative radiotherapy combined with chemotherapy for brain metastases from lung cancer. Methods Eighty-two patients with brain metastases from non-small cell lung cancer received systemic chemotherapy before and after radiotherapy. For intracranial multiple metastases, given the whole cranial radiotherapy, the mid-planar dose of 33 ~ 39Gy / 11 ~ 13 times; as a single metastasis, first give the whole cranial radiotherapy, the median plane dose 30Gy/10 times, after the contraction field increase 15Gy/5 times. 20% mannitol and dexamethasone were dehydrated during radiotherapy. Results The 1-year survival rate of the whole group was 46.7% and 6.7% respectively. The 1-year and 2-year survival rates of the patients with extracranial metastases were 32.4% and 4.4%, respectively. The survival rate for intracranial metastases was 61.2% and 8.8%. There was a significant difference between the two groups (P = 0). .0 0 3). The survival rates in the two groups were 8 months and 12 months, respectively. Multivariate analysis showed that the pathological types of primary lesions and the number of intracranial metastases were not associated with survival. A survey of 51 deaths showed that 45.1% (2 3/5 1) of the patients died of systemic extensive metastasis with multiple organ failure, and 29.4% (15 /5 1) died of brain metastases. The proportion of primary lesions accounted for 25.5% (13/5 1). During and after radiotherapy, no serious CNS complications were observed. During the monthly brain CT or MR follow-up after radiotherapy, no signs of significant intracranial tissue damage were found. Conclusion The survival rate of patients with isolated intracranial metastases was significantly higher than that with extracranial metastases. There was no significant correlation between the survival rate and pathological types of primary lesions and the number of intracranial metastases.