【摘要】 目的:探讨调强放射治疗(intensity modulated radiation therapy,IMRT)非小细胞肺癌(non-small cell lung cancer,NSCLC)脑转移的可行性。方法:选择NSCLC脑转移初治患者30例,分析近期疗效、治疗前后生活质量和毒副作用,与重新设计全脑加后程三维适形(WBRT+3DCRT)和立体定向(WBRT+SRT)放疗计划相比,通过癌旁正常脑组织剂量体积特点分析IMRT的优势。结果:30例患者完全缓解和部分缓解分别为16.7%(5/30)和33.3%(10/30)。治疗后全组IMRT后简短精神状态量表评分为25.67±2.73,较治疗前的22.90±4.94提高,P<0.001;治疗后3～5个转移灶者为24.77±3.24,较治疗前的19.23±4.64提高,P=0.001。全组治疗后日常生活能力量表评分为79.00±14.82,较治疗前的68.67±19.60提高,P<0.001;治疗后3～5个转移灶者为72.31±15.63,较治疗前的55.77±19.13提高,P=0.001。急性Ⅱ级损伤发生率为10%(3/30),晚期Ⅱ级毒副作用1例,Ⅳ级毒副作用1例。IMRT使瘤旁V35(147.56±80.77)、V40(50.86±32.33)和V45(22.32±15.40)明显较3DCRT和SRT减少,尤以3～5个病灶者显著,V35为214.56±58.09,V40为79.29±22.76,V45为34.17±12.64,P值均<0.05。结论:IMRT治疗NSCLC脑转移有效,毒副作用可耐受,转移病灶3～5个的患者选择IMRT可能更优。更多还原

【Abstract】 OBJECTIVE:To investigate the feasibility of clinical prospective study for brain metastases from non-small cell lung cancer(NSCLC) treated with intensity modulated radiotherapy(IMRT).METHODS:Thirty NSCLC untreated patients with brain metastases treated with IMRT.Through evaluating the response,quality of life before and after treatment,toxicity and normal brain tissue adjacent to the tumor dose-volume parameters,the advantages of IMRT was analyzed and compared to redesigned three-dimesional conformal radiation therapy(3D-CRT) or stereotactic radiotherapy(SRT) plans.RESULTS:Complete remission was 16.7%(5/30),partial remission was 33.3%(10/30).Mini-mental state examination score(all patients 25.67±2.73,three to five metastases patients 24.77±3.24) and activities of daily living score(all patients 79.00±14.82,three to five metastases patients 72.31±15.63) after treatment were higher than that before treatment(the former all patients 22.9±4.94,three to five metastases patients 19.23±4.64;the later all patients 68.67±19.60,three to five metastases patients 55.77±19.13),especially with three to five brain metastases lesions(P<0.05).Acute injury of grade Ⅱ was 10%(3/30) and late injury of grade Ⅱ,Ⅳ was in one patient.Dose volume V35(147.56±80.77),V40(50.86±32.33) and V45(22.32±15.40) in normal tissue adjacent to the brain tumor was obviously decreased in IMRT,especially within three to five metastases lesions(V35 214.56±58.09,V40 79.29±22.76,V45 34.17±12.64,P<0.05).CONCLUSIONS:IMRT treatment of NSCLC brain metastases is effective and the toxicity can be tolerated.For the patients with 3-5 brain metastases lesions selecting IMRT may be a better choice.更多还原