林辉, 梁瑜, 孙恒文, 李伟雄, 谢松喜. 靶向治疗时代全脑同步整合加量调强放疗对肺腺癌多发或大体积脑转移患者的疗效分析[J]. 循证医学, 2019, 19(6): 358-363. DOI: 10.12019/j.issn.1671-5144.2019.06.010
    引用本文: 林辉, 梁瑜, 孙恒文, 李伟雄, 谢松喜. 靶向治疗时代全脑同步整合加量调强放疗对肺腺癌多发或大体积脑转移患者的疗效分析[J]. 循证医学, 2019, 19(6): 358-363. DOI: 10.12019/j.issn.1671-5144.2019.06.010
    LIN Hui, LIANG Yu, SUN Heng-wen, LI Wei-xiong, XIE Song-xi. Whole Brain Irradiation Plus Simultaneous Integrated Boost Intensity-Modulated Radiotherapy in The Era of Targeted Therapies: An Analysis of Patients with Multiple or Large Volume Brain Metastases from NSCLC[J]. Journal of Evidence-Based Medicine, 2019, 19(6): 358-363. DOI: 10.12019/j.issn.1671-5144.2019.06.010
    Citation: LIN Hui, LIANG Yu, SUN Heng-wen, LI Wei-xiong, XIE Song-xi. Whole Brain Irradiation Plus Simultaneous Integrated Boost Intensity-Modulated Radiotherapy in The Era of Targeted Therapies: An Analysis of Patients with Multiple or Large Volume Brain Metastases from NSCLC[J]. Journal of Evidence-Based Medicine, 2019, 19(6): 358-363. DOI: 10.12019/j.issn.1671-5144.2019.06.010

    靶向治疗时代全脑同步整合加量调强放疗对肺腺癌多发或大体积脑转移患者的疗效分析

    Whole Brain Irradiation Plus Simultaneous Integrated Boost Intensity-Modulated Radiotherapy in The Era of Targeted Therapies: An Analysis of Patients with Multiple or Large Volume Brain Metastases from NSCLC

    • 摘要: 目的 探讨靶向治疗时代全脑同步整合加量调强放疗对多发或大体积脑转移肺癌患者的疗效及安全性。 方法 回顾性分析广东省人民医院放疗科58例非小细胞肺癌脑转移患者接受全脑同步整合加量调强放疗的疗效及毒副反应。 结果 58例患者全部接受了全脑同步整合加量调强放疗,8例(14%)患者完全缓解,46例(79%)患者部分缓解,4例(7%)患者疾病稳定。全组中位颅内无进展生存期为15.9 个月,中位放疗后颅内无进展生存期为12.4 个月;中位总生存期为21.6 个月,中位放疗后总生存期为18.4 个月。有驱动基因初治脑转移组、有驱动基因继发脑转移组和无驱动基因脑转移组患者的放疗后颅内无进展生存期(9.0个月vs. 10.4个月vs. 13.9个月,P=0.166)及放疗后总生存期 (13.7个月vs. 20.9个月vs. 16.9个月,P=0.762) 无明显差异;有驱动基因继发脑转移组和无驱动基因脑转移组的颅内无进展生存期(12.5个月vs. 14.7个月 vs. 25.7个月,P=0.047)及总生存期(22.5个月vs. 17.6个月vs. 30.6个月,P=0.048)差于有驱动基因初治脑转移组,差异有统计学意义。早期毒性反应(CTC V4.0)Ⅰ度54例,Ⅱ度3例,Ⅲ度1例,无Ⅳ度反应。晚期毒性反应(RTOG)Ⅰ度55例,Ⅱ度3例,无Ⅲ、Ⅳ度反应。 结论 全脑同步整合加量调强放疗对于肺癌多发或大体积脑转移患者具有较好疗效,毒副反应可耐受。

       

      Abstract: Objective In the era of targeted therapy, the efficacy and optimal dose of whole-brain radiotherapy+ simultaneous integrated boost (WBRT+SIB) for non-small cell lung cancer(NSCLC) patients with multiple or large volume brain metastases are unknown. This study analyzed the efficacy, safety and optimal dose of WBRT+SIB for NSCLC patients with multiple or large volume brain metastases. Methods Retrospective analysis was performed on the efficacy of WBRT+SIB in 58 patients with NSCLC brain metastasis in the Radiotherapy Department of Guangdong Provincial People's Hospital. Results 58 patients received WBRT+SIB, 8 patients (14%) achieved complete response(CR), 46 patients (79%) achieved partial response(PR), and 4 patients (7%) achieved stable disease(SD). The median intracranial overall survival(OS) was (21.6±2.5) months and post-radiotherapy OS (r-OS) was (18.4±2.4) months. There was no significant difference in post-radiotherapy intracranial progression-free survival(r-iPFS) and r-OS between mutant NSCLC with multiple brain metastases at time of diagnosis group, mutant NSCLC with multiple brain metastases after initial diagnosis and no mutant NSCLC with multiple brain metastases at time of diagnosis(9.0 vs. 10.4 vs. 13.9 months,P=0.166;13.7 vs. 20.9 vs. 16.9 months,P=0.762). The efficacy of intracranial-PFS(iPFS) and OS in no mutant NSCLC with multiple brain metastases at time of diagnosis and mutant NSCLC with multiple brain metastases after initial diagnosis, but worse than that in mutant NSCLC with multiple brain metastases at time of diagnosis group (12.5 vs. 14.7 vs. 25.7 months,P=0.047;17.6 vs. 22.5 vs. 30.6 months,P=0.048). Grade 1 acute toxicity(CTC V4.0) is reported in 54 cases, grade 2 in 3 cases, grade 3 in 1 case, no grade 4 case. Grade 1 late toxicity (RTOG) is reported in 55 cases, grade 2 in 3 cases, no grade 3 and grade 4 cases. Conclusion WBRT+SIB is effective in NSCLC patients with multiple or large volume brain metastases, with tolerable toxic and side effects.

       

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