【摘要】 目的　观察根据预后因素给予非小细胞肺癌 (NSCLC)脑转移不同放射剂量患者的耐受性及疗效。方法　对 75例未经治疗的非小细胞肺癌脑转移患者按如下方案入组 :A组 14例 ,脑内单一病灶、脑外无病灶 ,全脑放射剂量 30Gy,10分次后缩野至残留病灶 ,总剂量为 4 5Gy ,15分次 ;B组 2 9例 ,脑内多发病灶、脑外无病灶 ,全脑放射剂量 39Gy,13分次 ;C组 32例 ,脑内脑外全有病灶 ,全脑放射剂量 30Gy ,10分次。结果　近期疗效 :3个组放射治疗后颅内压增高症状 (头痛、恶心、呕吐等 )均得到缓解 ,神经压迫等神经功能受损症状A、B、C组缓解率分别为 10 0 % (7/ 7)、86 % (12 / 14 )、93% (14 /15 )。远期疗效 :总的中位局部控制时间 7.6个月 (0 .8～ 5 2 .7个月 ) ,1、2年局部控制率分别为 4 6 %、2 3% ;A、B、C组的 1和 2年局部控制率分别为 5 5 %和 38%、5 2 %和 2 6 %、33%和 10 %。生存情况 :总的中位生存期为 9.6个月 (0 .8～ 5 2 .8个月 ) ,1、2年生存率分别为 4 9%、2 6 % ;A、B、C组的 1和 2年生存率分别为 5 3%和 4 9%、5 0 %和 2 3%、4 5 %和 9%。副反应 :急性反应中A组 1例放射治疗中发生上消化道大出血 ,C组 1例放射治疗 2次癫痫发作。晚期不良反应中B组 2例有思维或 (和 )行为障碍及神经异常表现。Cox多因?更多还原

【Abstract】 Objective To observe the tolerance , effectiveness and prognostic factors of three different doses for non-small cell lung cancer (NSCLC) patients with brain metastasis. Methods Seventy-five NSCLC patients with known brain metastasis were irradiated in the following protocols. Group A whole brain irradiation to 30 ?Gy/10 fractions over 2 weeks then boosted to 45?Gy/15 fractions over 3 weeks for patients with only one lesion in the brain without any extracranial involvement(14 cases).Group B whole irradiation to 39?Gy/13 fractions over 2.5 weeks for patients with more than one lesion in the brain also without any extracranial involvement (29 cases). Group C whole irradiation to 30 ?Gy/10 fractions over 2 weeks for patients with both extracranial and brain lesions(32 cases). Results The incidence of symptom relief (pain,nausea and vomiting) was 100% in all groups.The incidences of neurological sign relief in groups A、B、C were 100%(7/7),86%(12/14),93%(14/15). The overall median local control duration was 7.6 months (0.8-52.7 months) . The overall 1-and 2-year local control rates were 46% and 23%.The 1-and 2-year local control rates of groups A, B,C were 55% and 38%, 52% and 26%, 33% and 10%,respectively. The overall median survival was 9.6 months (0.8-52.8 months). The overall 1-and 2-year survival rates were 49% and 26%.The 1-and 2-year survival rates of groups A, B,C were 53% and 49%,50% and 23%,45% and 9%,respectively. Side effects: None of these patients showed serious acute side effects except one in group A who developed gastrointestinal bleeding and one in group C who had epileptic seizures during the second session of irradiation. Late effects:Two patients in group B showed impairment in thought coherence and behavior though without any tumor in the brain after 23,17 months of irradiation. The results of Cox regression in local control suggested that higher dose may give better local control duration (P=0.003). And another result of Cox regression in the overall survival showed that KPS and local control of brain tumor might influence the overall survival duration(P=0 .0 5 1,0 .056) .Conclusions This protocol gives satisfactory local control and local control duration without necessitating over-treatment in some patients.It warrants further study .更多还原