SRT与SRS治疗肺腺癌脑转移瘤对比分析

doi:10.3760/cma.j.issn.1004-4221.2020.02.002

摘要
图/表
参考文献(13)
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (0 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS) 背景资料

摘要目的回顾性分析2006年1月至2016年12月间的肺腺癌脑转移瘤患者治疗疗效并进行相关因素分析。方法多中心回顾性分析肺腺癌脑转移瘤患者208例,其中SRT患者86例,SRS患者122例。分析两组患者的临床特征并比较两组局部肿瘤控制时间、中位生存期及放射性脑损伤情况。结果 SRT、SRS的肿瘤客观缓解率分别为70.9%、71.3%,12个月局部肿瘤控制率分别为89%、86%(P=0.383)。全组中位总生存期为14.3个月,其中SRT为15.6个月,SRS为13.7个月(P=0.349)。多因素分析显示患者预后不佳的主要因素为靶区总体积较大(P<0.001)、GPA评分较低(P=0.012)及无敏感基因突变(P<0.001)。SRT、SRS晚期放射性脑损伤发生率分别为5.8%、14.8%(P=0.043)。结论 SRT与SRS治疗肺腺癌脑转移瘤疗效相似,SRT可能比SRS有更低的晚期放射性脑损伤发生率。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	李勇
	刘风华
	梁康宁
	邵显军
	张丽
	梁晓华
	潘绵顺

关键词 ：脑转移/肺肿瘤, 立体定向放射疗法, 立体定向放射外科

Abstract：Objective To compare the clinical efficacy of stereotactic radiotherapy (SRT) and stereotactic radiosurgery (SRS) in the treatment of brain metastases from January 2006 to December 2016,lung adenocarcinoma and analyze the related factors. Methods In this multi-center retrospective analysis, clinical data of 208 patients with brain metastases from lung adenocarcinoma were retrospectively analyzed and assigned into the SRT (n=86) and SRS groups (n=122). The clinical characteristics of patients in two groups were analyzed. The local tumor control rate,median survival time and radiation brain injury were statistically compared between two groups. Results At the end of follow-up,the Objective response rates (ORR) were 70.9% and 71.3% in the SRT and SRS groups (P=0.772). The local tumor control rates at 12 months were 89% and 86% in the SRT and SRS groups (P=0.383). The median overall survival time of all patients was 14.3 months,15.6 months in the SRT group and 13.7 months in the SRS group (P=0.349). Multivariate analysis showed that large target volume (P<0.001),low GPA score (P=0.012) and no insensitive gene mutation (P<0.001) were the main factors of poor prognosis. The incidence of late radiation brain injury was 5.8% and 14.8% in two groups (P=0.043). Conclusions SRT and SRS yield similar clinical efficacy in the treatment of brain metastases from lung adenocarcinoma. SRT may have a lower incidence of late radiation brain injury than SRS.

Key words： Brain metastasis/lung neoplasms Stereotactic radiotherapy Stereotactic radiosurgery

收稿日期: 2019-09-20

基金资助:国家重点研发计划项目(2017YFC0113701);上海市长宁区肿瘤放射诊疗中心特色专科建设项目(20193006)

通讯作者: 潘绵顺,Email:panmianshun@126.com

引用本文:

李勇,刘风华,梁康宁等. SRT与SRS治疗肺腺癌脑转移瘤对比分析[J]. 中华放射肿瘤学杂志, 2020, 29(2): 88-92.

Li Yong,Liu Fenghua,Liang Kangning et al. A comparative analysis of SRT and SRS in the treatment of brain metastases from lung adenocarcinoma[J]. Chinese Journal of Radiation Oncology, 2020, 29(2): 88-92.

链接本文:

http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2020.02.002 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2020/V29/I2/88

[1] Preusser M,Capper D,Ilhan-Mutlu A,et al. Brain metastases:pathobiology and emerging targeted therapies[J]. Acta Neuropathol,2012,123(2):205-222. DOI:10.1007/s00401-011-0933-9.
[2] Lehrer EJ,Peterson JL,Zaorsky NG,et al. Single versus multifraction stereotactic radiosurgery for large brain metastases:an international Meta-analysis of 24 trials[J]. Int J Radiat Oncol Biol Phys,2019,103(3):618-630. DOI:10.1016/j.ijrobp.2018.10.038.
[3] Sheehan JP,Yen CP,Lee CC,et al. Cranial stereotactic radiosurgery:current status of the initial paradigm shifter[J]. J Clin Oncol,2014,32(26):2836-2846. DOI:10.1200/JCO.2013.53.7365.
[4] Chao ST,Ahluwalia MS,Barnett GH,et al. Challenges with the diagnosis and treatment of cerebral radiation necrosis[J]. Int J Radiat Oncol Biol Phys,2013,87(3):449-457. DOI:10.1016/j.ijrobp.2013.05.015.
[5] 潘绵顺,李勇,邱书珺,等. SRT联合贝伐珠单抗治疗肺腺癌脑转移瘤的疗效评估[J]. 中华放射肿瘤学杂志,2017,26(8):880-883. DOI:10.3760/cma.j.issn.1004-4221.2017.08.007.
Pan MS,Li Y,Qiu SJ,et al. Efficacy and safety of stereotactic radiotherapy combined with bevacizumab for brain metastases of lung adenocarcinoma[J]. Chin J Radiat Oncol,2017,26(8):880-883. DOI:10.3760/cma.j.issn.1004-4221.2017.08.007.
[6] Minniti G,Scaringi C,Paolini S,et al. Single-fraction versus multifraction (3×9 Gy) stereotactic radiosurgery for large (>2 cm) brain metastases:a comparative analysis of local control and risk of rRadiation-induced brain necrosis[J]. Int J Radiat Oncol Biol Phys,2016,95(4):1142-1148. DOI:10.1016/j.ijrobp.2016.03.013.
[7] Lucia F,Key S,Dissaux G,et al. Inhomogeneous tumor dose distribution provides better local control than homogeneous distribution in stereotactic radiotherapy for brain metastases[J]. Radiother Oncol,2019,130:132-138. DOI:10.1016/j.radonc.2018.06.039.
[8] 潘绵顺,李勇,邱书珺,等. 贝伐单抗治疗放射性脑坏死初步疗效分析[J]. 中华放射肿瘤学杂志,2015,24(4):434-437. DOI:10.3760/j.issn.1004-4221.2015.04.028.
Pan MS,Li Y,Qiu SJ,et al. Preliminary efficacy of bevacizumab for cerebral radiation necrosis[J]. Chin J Radiat Oncol,2015,24(4):434-437. DOI:10.3760/j.issn.1004-4221.2015.04.028.
[9] Mulvenna P,Nankivell M,Barton R,et al. Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ):results from a phase 3,non-inferiority,randomised trial[J]. Lancet,2016,388(10055):2004-2014. DOI:10.1016/S0140-6736(16)30825-X.
[10] Qin H,Wang C,Jiang Y,et al. Patients with single brain metastasis from non-small cell lung cancer equally benefit from stereotactic radiosurgery and surgery:a systematic review[J]. Med Sci Monit,2015,21(1):144-152. DOI:10.12659/MSM.892405.
[11] Aoyama H,Shirato H,Tago M,et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs.stereotactic radiosurgery alone for treatment of brain metastases:a randomized controlled trial[J]. JAMA,2006,295(10):2483-2491. DOI:10.1001/jama.295.21.2483.
[12] Kocher M,Soffietti R,Abacioglu U,et al. Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases:results of the EORTC 22952-26001 study[J]. J Clin Oncol,2011,29:134-141. DOI:10.1200/JCO.2010.30.1655.
[13] Fokas E,Henzel M,Surber G,et al. Stereotactic radiosurgery and fractionated stereotactic radiotherapy:comparison of efficacy and toxicity in 260 patients with brain metastases[J]. J Neurooncol,2012,109(1):91-98. DOI:10.1007/s11060-012-0868-6.