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中国癌症防治杂志

中国癌症防治杂志 ›› 2016, Vol. 8 ›› Issue (1): 22-26.doi: 10.3969/j.issn.1674-5671.2016.01.06

• 临床研究 • 上一篇    下一篇

放化疗联合脑转移瘤放疗治疗非小细胞肺癌脑转移的临床疗效分析

  

  1. 贵州省安顺市人民医院肿瘤科；贵州医科大学附属医院胸部肿瘤科/贵州省肿 瘤医院胸部肿瘤科；贵州医科大学组织工程及干细胞研究中心
  • 出版日期:2016-02-25 发布日期:2016-03-11
  • 通讯作者: 卢冰 lbgymaaaa@163.com
  • 基金资助:

    贵州省科技计划课题资助项目［黔科合J重大字（2015）2003］；贵州省科技计划课题资助项目［黔科合SY（2010）3078号］；贵州省科学技术基金资助项目［黔科合J字（2010）2186号］

Survival in patients with non-small cell lung cancer and brain metastasis treated with con-current thoracic chemoradiotherapy and brain radiation

  • Online:2016-02-25 Published:2016-03-11

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631

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被引次数

27

摘要：

目的 分析化疗同期胸部三维放疗联合脑转移瘤放疗治疗非小细胞肺癌（non-small cell lung cancer，NSCLC）单纯脑转移的疗效及影响预后的因素。方法 回顾性分析52例单纯脑转移且脑转移瘤及原发肿瘤均接受放疗的NSCLC患者的临床资料，Kaplan-Meier法计算生存率并行log-rank 检验，Cox回归模型行多因素预后分析。结果 全组患者中位随访时间为13.5个月（4～49个月），中位生存期为13.0个月（95% CI：11.2～14.8），1年、2年、3年生存率分别为53.8%、13.5%和3.8%。胸部原发肿瘤体积＜118 cm3组和≥118 cm3组的中位生存期分别为14.0个月（95% CI：11.6～16.4）和12.0个月（95%  CI：10.7～13.3），1年生存率分别为66.7%和42.9%，2年生存率分别为20.8%和0，3年生存率分别为8.3%和0，两组总生存率比较差异有统计学意义（χ2=5.648，P=0.017）。胸部原发肿瘤放疗剂量（dose to PTV，DTPTV）≥66 Gy组和DTPTV＜66 Gy组的中位生存期分别为13.0个月（95%  CI：10.8～15.2）和14.0个月（95%  CI：10.8～17.2），两组比较差异无统计学意义（χ2=0.064，P=0.80）。多因素预后分析显示，原发肿瘤体积是影响总生存率的独立预后因素。结论 化疗同期胸部三维放疗联合脑转移瘤放疗治疗NSCLC单纯脑转移取得较好疗效，原发肿瘤体积较小的患者生存获益更大。

关键词: 肺肿瘤, 脑转移, 化疗, 放射疗法, 疗效, 预后

Abstract:

Objective To investigate overall survival and prognostic factors of patients with non-small cell lung cancer （NSCLC） and brain metastasis treated with concurrent thoracic chemoradiotherapy and brain irradiation. Methods Clinical data were collected on 52 NSCLC patients with only brain metastases. All patients received radiation at the primary thoracic tumor and brain metastatic lesions. The Kaplan Meier method was used to calculate overall survival，and survival curves were compared using the log-rank test. Multivariate Cox regression was used to identify independent prognostic factors for overall survival. Results The median follow-up period was 13.5 months（range，4-49）. Median survival time was 13.0 months（95% CI，11.2-14.8），and overall survival rates were 53.8% at 1 year，13.5% at 2 years，and 3.8% at 3 years. Among patients with GTV＜118 cm3，median survival was 14.0 months （95% CI：11.6-16.4） and overall survival rates were 66.7% at 1 year， 20.8%　at 2 years，and 8.3% at 3 years. Among patients with GTV≥118 cm3， median survival was 12.0 months（95%  CI：10.7-13.3） and the corresponding overall survival rates were 42.9%，0 and 0（χ2=5.648，P=0.017）. Median survival time was 13.0 months （95%  CI：10.8-15.2） for patients who were prescribed a thoracic radiation dose ≥66 Gy，whereas it was 14.0 months（95%  CI，10.8-17.2） for those prescribed a dose ＜66 Gy（χ2=0.064，P=0.80）. Multivariate analysis showed that primary tumor volume was an independent prognostic factor for overall survival. Conclusions Concurrent thoracic chemoradiotherapy and brain radiation are associated with favorable overall survival in patients with NSCLC with only brain metastasis. Primary tumor volume may predict overall survival in these patients.

Key words:  Lung neoplasm, Brain metastasis, Chemoradiotherapy, Radiotherapy, Efficacy, Prognosis