伽玛刀治疗肺癌脑转移瘤生存与预后分析

摘要

Objective:To evaluate the survival and prognostic factors of Gamma -knife (GK)for patients with brain metastases(BM)from lung cancer.Methods:All 56 patients with BM after GK were retrospectively ananlyzed. Among them,there were 22 patients treated by stereotactic radiosurgery(SRS)alone,16 patients by stereotactic radio-therapy(SRT alone),9 patients by SRS combinated with whole brain radiotherapy(SRS +WBRT),7 patients were salvaged by SRS/SRT,2 patients salvaged by SRS+WBRT.Log rank method was used for univariate analyses.Cox regression model was used for multivariate analyses.Results:The 6 months and 1 year survival rate for all groups was 50%,10%,and median overall survival was 6 months.The 6 months survival rate for SRS alone group,SRT alonegroup,SRS +WBRT group,salvaged SRS /SRT group,and salvaged SRS +WBRT group were 59%,55%,40%,33%,0%,respectively.The median overall survival(MOS)were 8,9,6,5,3 months(P =0.005).Comparision a-mong groups,SRS vs SRT(P =0.157),SRS vs SRS +WBRT(P =0.551),SRT vs SRS +WBRT(P =0.266),sal-vaged SRS /SRT vs salvaged SRS +WBRT(P =0.177).The univariate analysis showed that the primary tumor con-trol,Histologicalal type,extra -cranial metastases disease,Karnofsky performance score(KPS),RPA class,site of le-sion,previous chemotherapy,previous intrcranial treatment,number of lessions were significant prognostic factors foroverall survival(P =0.000,0.013,0.002,0.000,0.000,0.000,0.043,0.011,0.037).The multivariate analysisshowed that the KPS score,primary tumor control,histologicalal type,previous intrcranial treatment were the independ-ent prognostic factors(P =0.000,0.005,0.006,0.002).Conclusion:There is no difference of survival among SRS,SRT and SRS +WBRT,even of salvage group for BMfrom lung cancer.KPS score,primary tumor control,histologicalaltype,previous intrcranial treatment were the independent prognostic factors for patients with BMfrom lung cancer.%目的：分析伽玛刀治疗肺癌脑转移瘤患者的生存及预后影响因素。方法：回顾性分析行伽玛刀治疗的56例肺癌脑转移瘤患者，单纯SRS组22例，单纯SRT组16例，联合全脑放疗（WBRT）组9例，行伽玛刀挽救组7例，行联合WBRT挽救组2例。Log rank法单因素分析影响预后的因素。结果：全组经治疗后6月、1年生存率分别为50％、10％，中位生存期为6个月。单纯SRS、单纯SRT、SRS联合WBRT、SRS/SRT挽救组、SRS＋WBRT挽救组6月生存率分别为59％、55％、40％、33％、0％，中位生存期分别为8、9、6、5、3个月（P＝0．005）。其中，SRS对SRT（P＝0．157）、SRS对SRS ＋WBRT（P＝0．551）、SRT对SRS ＋WBRT（P＝0．266）、SRS/SRT挽救组对SRS＋WBRT挽救组（P＝0．177）无统计学意义。单因素分析显示影响总生存率的因素有原发灶的控制情况、病理、中枢外转移情况、KPS评分、RPA分级、病灶所处位置、前期化疗、前期颅内治疗、病灶数目（P＝0．000、0．013、0．002、0．000、0．000、0．000、0．043、0．011、0．037）。多因素分析显示KPS评分、原发灶控制、病理、前期颅内处理影响生存（P＝0．000、0．005、0．006、0．002）。结论：用伽玛刀行单次SRS或分次SRT或与WBRT联合治疗在对生存获益上相似；KPS评分、原发灶控制情况、病理类型、前期颅内处理是影响生存的主要因素。