【作者】 蔡林波；

【导师】 陈龙华；

【作者基本信息】 南方医科大学 ， 放射治疗科， 2007， 硕士

【摘要】 目的：探讨不同放射治疗方法对肺癌脑转移瘤的疗效。方法：164例有病理学证实的肺癌脑转移瘤患者分为4组：单纯全脑放疗组(WBRT)32例、全脑放疗加立体定向放射外科组(WBRT+SRS)51例，全脑放疗加立体定向放射治疗组(WBRT+SRT)40例，单纯立体定向放射治疗组(SRT)41例。单纯全脑放疗组，1.8Gy～2.0Gy／次，总剂量3600cGy～4000cGy／18次～20次；全脑放疗加立体定向放射外科组，立体定向放射外科前或后行全脑放疗，立体定向放射外科单次1200～1600cGy(周边剂量)，全脑放疗3200cGy～3600cGy／16次～18次；全脑放疗加立体定向放射治疗组，单次靶区平均周边剂量300cGy～500cGy，总量2500～4000cGy。单纯立体定向放射治疗组，单次靶区平均周边剂量300cGy～500cGy，总量2500～6000cGy。其中鳞癌59例，腺癌82例，小细胞未分化癌23例。全组患者加或不加全身静脉化疗。结果：各组的局部控制率分别为46.9％，78.9％，87.5％，78％，中位生存期分别为5.0，12.0，12.0，10.0个月；局部无进展生存期分别为4.0，9.56，9.5，8.5个月；颅脑无新病灶生存期分别为4.0，10.5，9.0，8.5个月。单纯全脑放疗组死于脑转移的占62.5％，与其他3组相比有显著性差异(P=0.000)。而全脑放疗加立体定向放射外科组的晚期放射反应的发生率为23.5，较其它组高。结论：肺癌单发脑转移瘤患者的最佳治疗方式是单纯立体定向放射治疗。全脑放疗加立体定向放射治疗(WBRT+SRT)在提高多发脑转移瘤的生存率以及减少并发症方面优于其他治疗方法。更多还原

【Abstract】 Purpose: To evaluate the effects of various radiotherapeutic models for brainmetastasis from lung cancer. Methods: One hundred and sixty-four lung cancerpatients with brain metastasis pathologically proved were divided into fourgroups: 32 cases were whole brain radiotherapy (WBRY)alone, 51 cases werestereotactic radiosurgery(SRS) combined with WBRT, 40cases were stereotacticradiotherapy(SRT) combined with WBRT. 41 cases were stereotacticradiosurgery(SRS) alone. The dose fraction of whole brain radiotherapy was3600cGy～4000cGy in 18 to 20 fractions, 180cGy～200cGy perfraction. Stereotactic radiosurgery(SRS)were combined with whole brainradiotherapy (WBRY)before or behind , In stereotactic radiosurgery(SRS),singletumor target dose ranged from 1200cGy to 1600cGy, and the dose fraction ofwhole brain radiotherapy was 3200cGy～3600cGy in 16 to 18 fractions. Instereotactic radiotherapy(SRT)group,single tumor target dose ranged from 300cGy to500cGy with total dose 2500cGy to 6000cGy. Results: The response rates in fourgroups were 46.9%,78.9%,87.5%,78%,;median survival were 5.0,12.0, 12.0,10.0months respectively;the median of progression free survival(PFS) was4.0,9.56,9.5,8.5 months;the median survival willout new brain metastasis was4.0,10.5,9.0,8.5 months respeclively.There were 62.5% patients in WBRT alone failed due to brain metastasis, the significant difference to the other 3 groups wasfound (P=0.000). The long term complication rate in stereotactic radiosurgery(SRS)combined with WBRT group was 23.5%, the difference was statisticlly significantcompared with other 3 groups. Conclusion: SRS alone is the optional treatment forsingle brain metastasis. For multi-metastasis of brain, the effect of SRT combinedwith WBRT is better than that of other treatrments, not only in improving survival,butalso in reducing complication.更多还原