非小细胞肺癌脑转移瘤SIB-IMRT的临床应用研究

发布时间：2018-04-23 14:44

本文选题：非小细胞肺癌 + 脑转移　；参考：《贵州医科大学》2017年硕士论文

【摘要】：目的探讨1-5个病灶NSCLC脑转移同步推量调强放疗(SIB)的有效性、安全性。方法2009年7月-2015年7月1-5个病灶NSCLC脑转移患者完成治疗226例,其中SIB-IMRT组114例,3DCRT组62例,单纯WBRT组40例,单纯局部脑转移灶放疗组10例。观察疗效、毒性,并通过简易精神状态量表(MMSE)和日常生活能力量表(ADL)评价SIB-IMRT组及3DCRT组治疗后6个月生活质量变化。未行颅内转移灶放疗的50例进行死亡因素分析。结果SIB-IMRT组、3DCRT组、单纯WBRT组与单纯局部脑转移灶放疗组RR分别为53.8%、42.9%、50.0%、42.9%,脑转移相关1、2年OS及MST分别为47.9%和23.9%及16个月、45.0%和15.0%及12个月、0%和0%及9个月、0%和0%及7个月。分层分析1-2个脑转移灶病例SIB-IMRT组与单纯WBRT组的RR具有统计学差异(z2=-0.892,P2=0.011)。四组患者颅内复发无统计学差异,且多数死于颅外肿瘤未控。未行治疗的患者中位生存期为2个月。SIB-IMRT照射的平均时间为15.29天,明显缩短,具有统计学意义。SIB-IMRT和3DCRT组治疗前后MMSE评分无显著差异,分层分析1-2个脑转移灶病例SIB-IMRT组3个月后有下降趋势,6个月后恢复,而3DCRT组治疗后呈持续下降的走向;3-5个转移灶病例两组均呈上升走向,无显著差异。SIB-IMRT组ADL评分治疗前与治疗1月后具有统计学差异(t=-2.459,P=0.017);3DCRT组治疗前后ADL评分无显著差异;分层分析无论1-2个转移灶或3-5个,SIB-IMRT组1月后有上升走向,3个月有下降趋势,6个月后恢复;1-2个转移灶3DCRT组治疗后呈不断下降走向,3-5个转移灶3DCRT组治疗后呈升高走向。SIB-IMRT与单纯WBRT组在中枢神经系统急性毒副反应发生率差异有统计学差异(P=0.019),但与3DCRT组及单纯脑转移灶放疗组相比无统计学差异。结论SIB-IMRT技术安全、有效,未发现明显认知功能和生活能力改变,急性毒副反应可耐受,显著缩短放疗时间,为患者争取其它治疗时间。
[Abstract]:Objective to evaluate the efficacy and safety of 1-5 NSCLC brain metastases with simultaneous push intensity modulated radiotherapy (IMRT). Methods from July 2009 to July 2015, 226 patients with NSCLC brain metastases from July 2009 to July 2015 were treated, including 62 cases in SIB-IMRT group, 40 cases in WBRT group and 10 cases in radiotherapy group with local brain metastases. The efficacy and toxicity were observed, and the quality of life (QOL) of SIB-IMRT group and 3DCRT group were evaluated 6 months after treatment by MMSE and ADL. Death factors were analyzed in 50 patients without intracranial metastases. Results the RR of SIB-IMRT group, WBRT group and radiotherapy group were 53.8% and 42.9%, respectively. The 1-, 2-year OS and MST were 47.9% and 23.9% and 45.0% and 15.0% and 12 months, 0% and 0%, and 9 months, 0% and 0% and 7 months, respectively. There was statistical difference in RR between SIB-IMRT group and WBRT group in 1-2 cases with brain metastases. There was no significant difference in intracranial recurrence among the four groups, and most of them died of uncontrolled extracranial tumors. The median survival time of untreated patients was 2 months. The mean time of SIB-IMRT irradiation was 15.29 days, which was significantly shortened. There was no significant difference in MMSE score between SIB-IMRT group and 3DCRT group before and after treatment. Stratified analysis showed a downward trend after 3 months and a recovery after 6 months in 1-2 patients with brain metastases in SIB-IMRT group. In the 3DCRT group, there was a continuous decreasing trend after treatment. In both groups, there was an upward trend in 3 to 5 metastatic foci in both groups. There was no significant difference in ADL score between before and after 1 month treatment in SIB-IMRT group. There was no significant difference in ADL score before and after treatment in SIB-IMRT group. Stratified analysis showed an upward trend after one month in 1-2 metastatic foci or 3-5 SIB-IMRT groups, a downward trend in 3 months, and an increasing trend in 3DCRT group after 6 months of recovery of 1-2 metastatic foci after treatment. The incidence of acute side effects in central nervous system in SIB-IMRT group was significantly different from that in simple WBRT group, but there was no significant difference between SIB-IMRT group and 3DCRT group and radiotherapy group with simple brain metastases. Conclusion the SIB-IMRT technique is safe and effective. There are no obvious changes in cognitive function and life ability. The acute toxic side effects can be tolerated and the time of radiotherapy can be significantly shortened so as to gain other treatment time for the patients.
【学位授予单位】：贵州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

【参考文献】