Suteu Patricia, Fekete Zsolt, Todor Nicolae, Nagy Viorica
Oncology-Radiotherapy Department, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania.
Oncology-Radiotherapy Department, "Prof. Dr. I. Chiricuta" Oncology Institute Cluj-Napoca, Romania.
Med Pharm Rep. 2019 Jan;92(1):43-51. doi: 10.15386/cjmed-1040. Epub 2019 Jan 15.
Brain metastases are the most frequent intracranial neoplasms in adults. Although overall survival (OS) is an important endpoint in patients receiving radiotherapy, given their poor life expectancy in general, quality of life is becoming an increasingly useful endpoint. Objectives: to evaluate whole brain radiotherapy (WBRT) with 3D conformal boost in brain metastases patients with regard to OS and quality of life.
During April 2015-May 2017, a total of 35 patients with ≤5, previously untreated, inoperable brain metastases were included prospectively. All patients underwent WBRT followed by 3D conformal boost to the metastatic lesions. EORTC quality of life questionnaires QLQ-C30 and QLQ-BN20 were used at baseline and at end of treatment. The mean initial and final scores were compared using Student test. One-year OS with brain metastases was computed with Kaplan Maier method.
Median survival with brain metastases was 4.43 months (0.73-78.53). The one-year OS for patients with one metastasis was 42% versus 15% for more than one (p<0.04). The presence of extracerebral metastases significantly decreased OS from 39% without extracerebral metastases to 19%. (p<0.05). Quality of life improved significantly in several functional domains: physical (48 vs 60.29), role functioning (28.1 vs 44.7), emotional (47.1 vs 80.2), global health status (40.9 vs 62.3). Symptom scores decreased significantly in most items, corresponding to an improvement in the symptom burden: headache (61.9 vs 0.9), nausea and vomiting (45.7 vs 7.1), visual disorder (26.3 vs 9.2), seizures (30.4 vs 0.9), motor dysfunction (46.6 vs 17.1). Symptom scores for fatigue and drowsiness increased significantly (51.1 vs 74.9, respectively 37.1 vs 70.4), indicating worsening of symptoms.
WBRT with 3D conformal boost is a feasible technique which improves quality of life in brain metastases patients. Since survival is limited, the assessment of quality of life is a good indicator of the treatment outcome.
脑转移瘤是成人中最常见的颅内肿瘤。尽管总生存期（OS）是接受放疗患者的一个重要终点指标，但鉴于这些患者总体预期寿命较短，生活质量正日益成为一个有用的终点指标。目的：评估三维适形加量全脑放疗（WBRT）对脑转移瘤患者总生存期和生活质量的影响。
2015年4月至2017年5月期间，前瞻性纳入了35例有≤5个未经治疗且无法手术切除的脑转移瘤患者。所有患者均接受了WBRT，随后对转移瘤灶进行三维适形加量放疗。在基线和治疗结束时使用欧洲癌症研究与治疗组织（EORTC）生活质量问卷QLQ-C30和QLQ-BN20。使用学生检验比较初始和最终的平均得分。采用Kaplan-Meier方法计算脑转移瘤患者的1年总生存期。
脑转移瘤患者的中位生存期为4.43个月（0.73 - 78.53）。单个转移瘤患者的1年总生存率为42%，而多个转移瘤患者为15%（p<0.04）。脑外转移的存在显著降低了总生存率，从无脑外转移时的39%降至19%（p<0.05）。生活质量在几个功能领域有显著改善：身体功能（48对60.29）、角色功能（28.1对44.7）、情绪功能（47.1对80.2）、总体健康状况（40.9对62.3）。大多数项目的症状评分显著降低，这对应于症状负担的改善：头痛（61.9对0.9）、恶心和呕吐（45.7对7.1）、视觉障碍（26.3对9.2）、癫痫发作（30.4对0.9）、运动功能障碍（46.6对17.1）。疲劳和嗜睡的症状评分显著增加（分别为51.1对74.9、37.1对70.4），表明症状恶化。
三维适形加量WBRT是一种可行的技术，可改善脑转移瘤患者的生活质量。由于生存期有限，生活质量评估是治疗效果的一个良好指标。
