小细胞肺癌（SCLC）脑转移的短程全脑放疗（WBRT）。

Short-course whole-brain radiotherapy (WBRT) for brain metastases due to small-cell lung cancer (SCLC).

作者信息

Bohlen Guenther, Meyners Thekla, Kieckebusch Susanne, Lohynska Radka, Veninga Theo, Stalpers Lukas J A, Schild Steven E, Rades Dirk

机构信息

Department of Radiation Oncology, University of Lubeck, Lubeck, Germany.

出版信息

Clin Neurol Neurosurg. 2010 Apr;112(3):183-7. doi: 10.1016/j.clineuro.2009.11.004. Epub 2009 Dec 3.

DOI:10.1016/j.clineuro.2009.11.004

Abstract

OBJECTIVE

Many patients with brain metastases due to SCLC have a poor survival prognosis. The most common treatment is whole-brain radiotherapy (WBRT). This retrospective study compares short-course WBRT with 5x4Gy in 1 week to standard WBRT with 10x3Gy in 2 weeks.

METHODS

Forty-four SCLC patients receiving WBRT with 5x4Gy were compared to 102 patients receiving 10x3Gy for survival (OS) and local (intracerebral) control (LC). Seven further potential prognostic factors were investigated: age, gender, Karnofsky Performance Score (KPS), number of brain metastases, extracerebral metastases, interval from tumor diagnosis to WBRT, RPA (Recursive Partitioning Analysis) class.

RESULTS

After 5x4Gy, 12-month OS was 15%, versus 22% after 10x3Gy (p=0.69). On multivariate analysis, improved OS was associated with age <or=60 years (p=0.013), KPS >or=70 (p<0.001), <4 brain metastases (p=0.011), and RPA class 1 (p<0.001). 12-month LC was 34% after 5x4Gy versus 25% after 10x3Gy (p=0.32). On multivariate analysis, improved LC was associated with KPS >or=70 (p<0.001), <4 brain metastases (p=0.027), and RPA class 1 (p<0.001).

CONCLUSION

In patients with brain metastases due to SCLC, short-course WBRT with 5x4Gy provided similar outcomes as 10x3Gy and appears preferable, particularly for patients with poor estimated survival.

摘要

目的

许多因小细胞肺癌发生脑转移的患者生存预后较差。最常见的治疗方法是全脑放疗（WBRT）。本回顾性研究比较了1周内5次4Gy的短程WBRT与2周内10次3Gy的标准WBRT。

方法

将44例接受5次4Gy WBRT的小细胞肺癌患者与102例接受10次3Gy WBRT的患者进行生存（OS）和局部（脑内）控制（LC）比较。还研究了另外7个潜在的预后因素：年龄、性别、卡诺夫斯基功能状态评分（KPS）、脑转移灶数量、脑外转移、从肿瘤诊断到WBRT的间隔时间、递归分区分析（RPA）分级。

结果

5次4Gy放疗后，12个月总生存率为15%，而10次3Gy放疗后为22%（p=0.69）。多因素分析显示，总生存率提高与年龄≤60岁（p=0.013）、KPS≥70（p<0.001）、脑转移灶<4个（p=0.011）和RPA分级1级（p<0.001）相关。5次4Gy放疗后12个月局部控制率为34%，10次3Gy放疗后为25%（p=0.32）。多因素分析显示，局部控制率提高与KPS≥70（p<0.001）、脑转移灶<4个（p=0.027）和RPA分级1级（p<0.001）相关。

结论

在因小细胞肺癌发生脑转移的患者中，5次4Gy的短程WBRT与10次3Gy的效果相似，似乎更可取，特别是对于预计生存较差的患者。