【摘要】 目的对比大分割(5×6 Gy)及中等剂量分割(20×2.5 Gy)两种调强放射治疗(IMRT)分割模式治疗实体瘤脑寡转移(1～4个病灶)的有效性和安全性。方法回顾分析2014年1月至2018年6月于江门市中心医院肿瘤科行IMRT的实体瘤脑寡转移患者86例。其中转移瘤灶剂量30 Gy(5×6 Gy)19例(大分割放疗组),50 Gy(20×2.5 Gy)67例(对照组)。采用倾向性评分匹配法对两组患者的性别、年龄、原发肿瘤、肿瘤最大直径、颅外病灶情况、是否同时全身治疗等6个因素行1∶2最小毗邻法匹配,最终对照组纳入38例。参照Recist 1.1标准评价放疗后疗效,计算有效率(ORR)。记录患者放疗期间不良反应发生情况。采用Kaplan-Meier法绘制生存曲线,比较两组颅内局部控制(LC)、颅内远处控制(DC)差异。采用Cox回归分析LC、DC的影响因素。结果大分割放疗组、对照组分别有31、60个病灶。大分割放疗组与对照组ORR差异无统计学意义[78.9%(15/19)vs. 68.4%(26/38),χ~2=0.404,P=0.659],放疗期间不良反应发生率差异无统计学意义[31.6%(6/19)vs. 21.1%(8/38),χ~2=0.811,P=0.677]。随访期间,大分割放疗组、对照组分别出现8、18例放疗病灶局部进展,中位LC时间分别为8.5、9.0个月;出现15、27例颅内远处转移,中位DC时间分别为8.0、9.0个月,两组LC和DC差异均无统计学意义(Log-rank χ~2分别为0.037、0.036,P>0.05)。全身治疗、病灶数是LC的独立影响因素;病灶数是DC的独立影响因素。结论大分割(5×6 Gy)及中等剂量分割(20×2.5 Gy两种IMRT分割模式对实体瘤脑寡转移患者预后的影响相当,急性脑放射反应无显著差异。对脑寡转移患者给予分割次数较少的大分割方案(5×6 Gy)IMRT是可行的。更多还原

【Abstract】 Objective The purpose of this study is to compare the effective and safety of two radiotherapy schedules(5×6 Gy vs. 20×2.5 Gy) for patients with solid tumor brain oligometastasis(metastatic sites≤4). Methods This is a retrospective review of 86 patients with solid tumor brain oligometastasis who underwent intensity-modulated radiotherapy between January 2014 and June 2018 in our hospital. 19 patients as the hypofractionated radiotherapy group with radiation dose of 30 Gy(6 Gy×5), whereas, 67 patients as control group with routine fraction radiation control group with radiation dose of 50 Gy(2.5 Gy×20). Nearest neighbor matching algorithm with 1∶2 of the two well balanced covariates groups were applied to propensity score matching method with 6 factors, including gender, age, primary tumor, maximum diameter of tumor, extracranial lesions, and whether with system therapy. Kaplan-Meier plotter Log-rank were applied for survival analysis. Univariate and multivariate analysis were utilized to compare the outcomes of the two radiotherapy fraction models for local control(LC) and distance brain control(DC) rates. Results The irradiated sites for the hypofractioned and control group were 31 and 60, respectively. The difference in ORR was not statistically significant [78.9%(15/19) vs. 68.4%(26/38), χ~2=0.695,P=0.537]. There was no significant difference in acute radiation related adverse events rate [31.6%(6/19) vs. 21.1%(8/38), χ~2=0.811,P=0.677]. 8(57.9%) patients of hypofractioned radiation group and 18(52.6%) patients of control group experienced progression of the radiated locoregional sites, with median locoregional failure time 8.5 months and 9.0 months, respectively. There was no significant difference. 15 patients and 27 patients in the two groups experienced intracranial metastasis, with median locoregional failure time 8.0 months and 9.0 months, respectively. There was no statistical difference.Conclusions The two radiotherapy schedules(5×6 Gy vs. 20×2.5 Gy)for patients with solid tumor brain oligometastasis had comparable prognosis. No difference of incidence of irradiation induced acute encephalopathy were observed in two groups. It is feasible to apply the hypofrationed radiation(6×5 Gy) for the brain oligometastasis patients.更多还原