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目的 探讨X射线立体定向放射治疗多发脑转移瘤的疗效。方法 在 4种预后因素(年龄、治疗前卡氏评分、有无其他部位转移及转移灶数目 )相同或相似的条件下 ,配对选择两组病例。X射线立体定向放射治疗加常规放射治疗组 (研究组 )和常规放射治疗组 (对照组 )各 53例。在研究组中 ,X射线立体定向放射治疗采用单次照射 40例 ,分次照射 1 3例 ;单次靶区平均周边剂量为 2 0Gy,分次照射剂量为 4～ 1 2Gy/次 ,2次 /周 ,总剂量为 1 5～ 30Gy。X射线立体定向放射治疗结束后即开始全脑放射治疗。对照组采用全脑照射 30～ 40Gy,3～ 4周。结果 研究组和对照组中位生存期分别为1 1 .6、6 .7个月 (P <0 .0 5) ;1年生存率分别为 44 .3 %、1 7.1 % (P <0 .0 1 ) ;1年局部控制率分别为50 .9%、1 3 .2 % (P <0 .0 5) ;治疗后 1个月卡氏评分增加者分别占 69.8%、30 .2 % (P <0 .0 1 ) ;治疗后 3个月影像学上的有效率分别为 82 .0 %、55 .0 % (P <0 .0 1 )。在死因分析中 ,研究组死于脑转移的占2 3 .3 % ,比对照组的 51 .0 %低 (P <0 .0 5)。两组病例放射并发症的发生率相似。结论 对于多发脑转移瘤 ,X射线立体定向放射治疗加常规放射疗在提高局部控制率、延长生存期和提高生存质量方面均优于单纯放射治疗。
Objective To investigate the efficacy of X-ray stereotactic radiotherapy in multiple brain metastases. Methods Two groups of patients were selected by pairing under the same or similar conditions of four prognostic factors (age, pre-treatment Karnofsky score, presence or absence of other sites of metastases and number of metastases). X - ray stereotactic radiotherapy plus conventional radiotherapy (study group) and conventional radiotherapy group (control group) each 53 cases. In the study group, X-ray stereotactic radiotherapy with a single irradiation of 40 cases, 13 cases of fractionated irradiation; single target area average peripheral dose of 20Gy, fractional irradiation dose of 4 ~ 1 2Gy / times, twice / Week, the total dose of 15 ~ 30Gy. Whole-brain radiation therapy started after X-ray stereotactic radiotherapy. Control group using whole brain irradiation 30 ~ 40Gy, 3 ~ 4 weeks. Results The median survival time of the study group and the control group were respectively 1.16,6.7 months (P <0.05). The 1-year survival rates were 44.3% and 7.11% (P <0. 0 1). The local control rates in one year were 50.9% and 13.2% (P <0.05), respectively. The increase in the score of cardiocytosis in one month after treatment was 69.8% and 30.2% respectively P <0.01). The three months after treatment, the imaging efficiencies were 82.0% and 55.0%, respectively (P <0.01). In the analysis of cause of death, the study group died of brain metastases accounted for 23.3%, 51.0% lower than the control group (P <0. 05). The incidence of radiation complications in both groups was similar. Conclusion For multiple brain metastases, X-ray stereotactic radiotherapy and conventional radiotherapy are superior to radiotherapy alone in improving local control rate, prolonging survival and improving quality of life.