非小细胞肺癌脑转移放疗疗效及预后分析

发布时间：2018-03-11 12:51

  本文选题：预后因素　切入点：脑转移　出处：《浙江大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：本研究旨在探讨接受全脑放疗(WBRT)为基础的综合治疗的非小细胞肺癌脑转移患者的预后因素以及脑转移瘤放疗后影响其局部疗效的相关因素。 材料和方法：本研究入组了135例接受全脑放疗的非小细胞肺癌脑转移患者,其中47(34.8%)例接受了加量放疗,84(62.2%)例接受了全身化疗,39(28.9%)例接受了表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKIs)治疗,对其预后影响因素进行分析。并对其中有头颅MRI随访资料的患者针对其脑转移瘤放疗后反应(56例患者,235个脑转移瘤)及局部控制率(60例患者,245个脑转移瘤)的潜在影响因素进行分析。 结果：全组患者的中位总生存期为9.3个月,1年和2年总生存率分别为46.3%和16.1%。单因素分析提示“年龄60岁”、“无颅外转移”、“KPS≥70分”、“诊断脑转移后化疗数≥3周期”、“联合EGFR-TKIs治疗”、“无小脑转移”与预后良好密切相关。多因素分析提示“无颅外转移”、“KPS≥70分”、“诊断脑转移后化疗数≥3周期”、“接受EGFR-TKIs治疗”、“无小脑转移”是预后良好的独立影响因素。对其中58例存在1-3个脑转移灶的患者进行亚组分析发现,全脑放疗联合加量放疗与预后良好密切相关。60例有头颅MRI随访资料的患者(共245个脑转移瘤)的中位随访时间6.1月(1-21.8月),其中进入放疗反应分析的235个脑转移瘤放疗后三个月总反应率62.6%,全组245个脑转移瘤的6个月局部控制率88.9%,1年的局部控制率70.2%。单因素分析提示“女性”、“腺癌”、“KPS70",“脑转移瘤最大径≤1cm"、“MRI中脑转移瘤实性强化”、“放疗后3月内化疗数≥2周期”与脑转移瘤放疗后容易出现近期反应密切相关,“腺癌”、“KPS70分”、“脑转移瘤最大径≤1cm”、“放疗后无进展期间化疗数≥3周期”与脑转移瘤放疗后局部控制良好密切相关。多因素分析提示“腺癌”、“增强MRI中脑转移瘤实性强化”、“放疗后3月内化疗≥2周期”是脑转移瘤容易出现放疗后反应的独立影响因素,同时“脑转移瘤最大径≤1cm”、“放疗后无进展期内化疗数≥3周期”是放疗后脑转移瘤局部控制良好的独立影响因素。 结论：我们不但验证了以往报道的预后因素,而且在我们的研究中发现无小脑转移是预后良好的独立影响因素。同时我们发现病理、脑转移瘤性质、化疗是影响脑转移瘤放疗后反应的独立影响因素。脑转移瘤大小和化疗是脑转移放疗后局部控制的独立影响因素。
[Abstract]:Objective: to investigate the prognostic factors of patients with brain metastases from non-small cell lung cancer (NSCLC) treated with WBRT-based whole brain radiotherapy (WBRT) and the factors related to the local efficacy of brain metastases after radiotherapy. Materials and methods: 135 patients with brain metastases from non-small cell lung cancer receiving whole brain radiotherapy were enrolled in this study. Among them, 47 / 34.8) received additional radiotherapy (84 / 62.2) and systemic chemotherapy (3928.9) / EGFR-TKIs. the epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKIs) was used. The prognostic factors were analyzed, and the potential of 56 patients with brain metastases, 235 brain metastases, and 60 patients with local control rate and 245 brain metastases were analyzed in the patients with cranial MRI follow-up data (56 patients with brain metastases after radiotherapy, 235 patients with brain metastases) and 60 patients with local control rate (60 patients with brain metastases) and 245 patients with brain metastases (n = 245). The influencing factors were analyzed. Results: the median total survival time was 9. 3 months, and the overall 1 year and 2 year survival rates were 46.3% and 16. 1 respectively. Univariate analysis showed that "age 60", "no extracranial metastasis", "KPS 鈮，

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