非小细胞肺癌脑转移患者全脑放疗不同剂量预后分析

doi:10.3760/cma.j.cn113030-20210405-00140

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摘要目的分析非小细胞肺癌(NSCLC)脑转移患者不同全脑放疗(WBRT)剂量的预后及影响因素。方法回顾性分析2013—2015年间于河北医科大学第四医院行WBRT的 244例NSCLC脑转移患者。按照不同WBRT剂量(EQD2Gy)分为 30~39Gy组 104例、≥40Gy组 140例。比较两组患者颅内无进展生存(iPFS)和总生存(OS),根据患者脑转移个数、GPA评分、卡氏评分、有无化疗及靶向治疗进一步分析不同WBRT剂量的预后。结果所有患者中位iPFS期为6.9个月,中位OS期为11.8个月。单因素分析显示两组患者 1年iPFS率和OS率分别为22.5%、25.4%(P=0.430)和41.1%、46.4%(P=0.068)。多因素分析显示不同WBRT剂量和改善iPFS和OS无关,影响iPFS因素为否局部补量、性别、脑转移数目、是否化疗和靶向治疗,影响OS因素为性别、脑转移数目、是否化疗和靶向治疗。亚组分析显示卡氏评分≥90患者,WBRT≥40Gy组 1年OS率优于 30~39Gy组(P=0.047),iPFS率相近(P=0.068);有化疗患者,WBRT≥40Gy组 1年iPFS、OS率均优于 30~39Gy组(P=0.017、0.012);有靶向治疗患者,WBRT≥40Gy组 1年iPFS、OS率均优于 30~39Gy (P=0.012、P=0.045)。结论 30~39Gy可能是NSCLC脑转移患者WBRT的合适剂量,WBRT≥40Gy并未带来更多获益。对于高卡氏评分或有积极全身治疗的NSCLC脑转移患者,WBRT≥40Gy可能获益。

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	申东星
	刘志坤
	李振生
	韩慧娜
	尚宇光
	朱龙玉
	孔德友
	张舰
	曲福印
	张钧

关键词 ：癌,非小细胞肺,脑转移/全脑放射疗法, 剂量, 预后

Abstract：Objective To analyze the prognosis and influencing factors of patients with brain metastases from non-small cell lung cancer (NSCLC) treated with different doses of whole brain radiotherapy (WBRT). Methods A total of 244 NSCLC patients with brain metastases who underwent WBRT in the Fourth Hospital of Hebei Medical University from 2013 to 2015 were analyzed retrospectively. According to different doses of WBRT (EQD2Gy), they were divided into the 30-39Gy group (n= 104) and ≥40Gy group (n= 140). The intracranial progression-free survival (iPFS) and overall survival (OS) were compared betweentwo groups. According to the number of brain metastases, GPA score, KPS score, chemotherapy and targeted therapy, the prognosis of different doses of WBRT was further analyzed. Results The median iPFS and OS of all patients were 6.9 months and 11.8 months, respectively. Univariate survival analysis:the 1-year iPFS and 1-year OS between two groups were 22.5% and 25.4%(P=0.430) and 41.1% and 46.4%(P=0.068), respectively. Multivariate survival analysis:different doses of WBRT were not associated with the improvement of iPFS and OS;independent factors influencing iPFS included local boost, gender, number of brain metastases, chemotherapy and targeted therapy;independent factors influencing OS included gender, number of brain metastases, chemotherapy and targeted therapy. Subgroup analysis:in patients with KPS≥90, the 1-year iPFS and OS of patients with WBRT ≥ 40Gy were seemingly better than those of their counterparts with 30-39Gy, but the difference was statistically significant only in OS (P=0.047), the difference was not statistically significant in iPFS (P=0.068);in patients with chemotherapy, the 1-year iPFS and OS of patients with WBRT≥40Gy were better than those of their counterparts with 30-39Gy (P=0.017, P=0.012);in patients with targeted therapy, the 1-year iPFS and OS in the WBRT≥40Gy group were better than those in the 30-39Gy group (P=0.012, P=0.045). Conclusions The 30-39Gy may be the appropriate dose of WBRT for NSCLC patients with brain metastases. WBRT≥40Gy does not bring more benefits. WBRT≥40Gy may benefit NSCLC patients with brain metastases with high KPS score or active systemic therapy.

Key words： Carcinoma,non-small cell lung, brain metastasis/whole brain radiotherapy Dose Prognosis

收稿日期: 2021-04-05

通讯作者: 张钧,Email:zhangjun1965@163.com

引用本文:

申东星,刘志坤,李振生等. 非小细胞肺癌脑转移患者全脑放疗不同剂量预后分析[J]. 中华放射肿瘤学杂志, 2022, 31(4): 340-346.

Shen Dongxing,Liu Zhikun,Li Zhensheng et al. Prognostic analysis of patients with brain metastases from non-small cell lung cancer treated with different doses of whole brain radiotherapy[J]. Chinese Journal of Radiation Oncology, 2022, 31(4): 340-346.

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