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目的评价三维适形放疗非小细胞肺癌脑转移临床疗效、不良反应以及预后。方法 65例非小细胞肺癌脑转移患者行全脑放疗(whole brain radiotherapy,WBRT)PTVwb40-50Gy/20-25F或WBRT PTVwb40Gy/20F,同步脑转移灶(pGTVs)加量至60Gy/20F或WBRT PTVwb40Gy/20F后pGTVs再补量20Gy/10F。所有病人均每周接受放疗5次。放疗结束1个月后评价疗效、不良反应。结果 65例均完成放疗计划,其中疗效分完全缓解(complete response,CR)4例(6.15%)、部分缓解(partial response,PR)23例(35.38%)、疾病稳定(stable disease,SD)33例(50.77%)、疾病进展(progression of disease,PD)5例(7.69%),总有效率(CR+PR)41.54%,临床获益率(CR+PR+SD)92.31%。1、2年生存率分别为52.31%(34例)、12.31%(8例)。主要不良反应为脑水肿、乏力、脱发、骨髓抑制、听力下降、记忆力轻度减退,Ⅲ-Ⅳ级神经系统不良反应4例(6.15%)。结论三维适形放疗治疗脑转移瘤能延长其生存期,不良反应可耐受。转移灶加量与单纯全脑放疗相比,未明显提高局控率和总生存率。预后评价分级(graded prognostic assessment,GPA)越高,患者生存时间越长;年龄越大、一般状况评分(karnofsky performance scale,KPS)越低、肿瘤脑转移灶数量越多以及颅外转移灶越多,患者生存期越短。
Objective To evaluate the clinical efficacy, adverse reactions and prognosis of three-dimensional conformal radiation therapy for brain metastasis of non-small cell lung cancer. Methods Sixty-five patients with brain metastases from non-small cell lung cancer undergoing whole brain radiotherapy (PTBW-40-50Gy / 20-25F or WBRT PTVwb40Gy / 20F) were treated with 60Gy / 20F or WBRT PTVwb40Gy / 20F pGTVs complement 20Gy / 10F. All patients received radiotherapy 5 times a week. 1 month after the end of radiotherapy evaluation of efficacy, adverse reactions. Results All 65 patients underwent radiotherapy. Among them, 4 patients (6.15%) had complete response (CR), 23 (35.38%) had partial response (PR), 33 had stable disease (SD) (50.77%), progression of disease (PD) in 5 cases (7.69%), total effective rate (CR + PR) 41.54% and clinical benefit rate (CR + PR + SD) 92.31%. The 1-year and 2-year survival rates were 52.31% (34 cases) and 12.31% (8 cases), respectively. The main adverse reactions were cerebral edema, fatigue, alopecia, myelosuppression, hearing loss, mild memory loss, grade Ⅳ-Ⅳ neurological adverse reactions in 4 cases (6.15%). Conclusion Three-dimensional conformal radiotherapy for brain metastases can prolong its survival, adverse reactions can be tolerated. Metastasis plus dose compared with pure whole brain radiotherapy, did not significantly improve the control rate and overall survival rate. The higher the graded prognostic assessment (GPA), the longer the patient’s survival time. The higher the age, the lower the Karnofsky performance scale (KPS), the more the number of brain metastases and the more extracranial metastases , The shorter the patient’s survival.