颅内转移瘤放射治疗方案的优化

摘要

Objective:To evaluate clinical curative effect of intracranial metastatic tumor treated by the whole brain radiotherapy combined stereotactic radiosurgery. Methods:Retrospective survival analysis was performed using the database between July 2005 and July 2008 on 50 patients who were diagnosed as having brain metastasis. All 50 patients with primary tumor controlled were assigned to two groups according to therapeutic schedule,one group of 30 cases was given whole brain radiotherapy and stereotactic radiosurgery( combination group),another group of 20 cases was treated by stereotactic radiosurgery alone( single group). Stereotactic radiosurgery prescription doses of 45% -75% isodose line were used to wrap around the planning target,which was 15-20Gy in edge and 30-45Gy in cen-ter. Stereotactic radiosurgery was performed once. Whole brain radiotherapy total dose was 40Gy,which was given to patients by 2Gy in 1 fraction,1 fracion every day,5 times every week. Results:The effect of combination group was obviously higher than that of a single group(p<0. 05). The 1 year,2 years survival rates of two groups were not dif-ferent(p>0. 05),there was no more than 3 years survival patients in two groups. The result showed that no signifi-cant difference in survival rate of patient with single lesion between the two groups. The survival rate of patients with more than two tumor lesions treated with whole brain radiotherapy combined stereotactic radiosurgery was significantly higher than that treated with stereotactic radiosurgery alone. Conclusion:For patients with multiple intracranial metas-tases,whole brain radiotherapy combined stereotactic radiosurgery is optimal selection scheme. For patients with solita-ry intracranial metastases,to whole brain radiotherapy and stereotactic radiosurgery or stereotactic radiosurgery treat-ment directly.%目的：探讨颅内转移瘤放射治疗的优化方案。方法：回顾性分析2005年7月-2008年7月收治的50例颅内转移瘤患者。原发灶均得到控制，30例采用全脑放疗+立体定向放射外科（联合组），20例采用单纯立体定向放射外科（单一组）。立体定向放射外科处方剂量均采用45%-75%等剂量线包绕计划靶区，边缘剂量15-20Gy，中心剂量30-45Gy，一次完成。全脑放疗每次分割剂量为2Gy，1次/d，5次/w，总剂量40Gy/4w。结果：联合组的有效率明显高于单一组（p<0.05）。两组1年、2年生存率比较无差异（p>0.05）。两组均无生存3年以上患者。按病灶数进行分层研究：1年生存率单发病灶两组差异无显著性（ p=0.212），1年生存率多发病灶联合组明显优于单一组（ p=0.001），2年生存率两组差异无显著性。结论：对于多发颅内转移瘤患者，全脑放疗联合立体定向放射外科是比较优化的选择方案，而对于单发的颅内转移瘤患者，则可以先全脑放疗加立体定向放射外科或者直接立体定向放射外科治疗。