本文選題：非小細胞肺癌 + 腦轉(zhuǎn)移��； 參考：《貴州醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的探討1-5個病灶NSCLC腦轉(zhuǎn)移同步推量調(diào)強放療(SIB)的有效性、安全性。方法2009年7月-2015年7月1-5個病灶NSCLC腦轉(zhuǎn)移患者完成治療226例,其中SIB-IMRT組114例,3DCRT組62例,單純WBRT組40例,單純局部腦轉(zhuǎn)移灶放療組10例。觀察療效、毒性,并通過簡易精神狀態(tài)量表(MMSE)和日常生活能力量表(ADL)評價SIB-IMRT組及3DCRT組治療后6個月生活質(zhì)量變化。未行顱內(nèi)轉(zhuǎn)移灶放療的50例進行死亡因素分析。結(jié)果SIB-IMRT組、3DCRT組、單純WBRT組與單純局部腦轉(zhuǎn)移灶放療組RR分別為53.8%、42.9%、50.0%、42.9%,腦轉(zhuǎn)移相關(guān)1、2年OS及MST分別為47.9%和23.9%及16個月、45.0%和15.0%及12個月、0%和0%及9個月、0%和0%及7個月。分層分析1-2個腦轉(zhuǎn)移灶病例SIB-IMRT組與單純WBRT組的RR具有統(tǒng)計學(xué)差異(z2=-0.892,P2=0.011)。四組患者顱內(nèi)復(fù)發(fā)無統(tǒng)計學(xué)差異,且多數(shù)死于顱外腫瘤未控。未行治療的患者中位生存期為2個月。SIB-IMRT照射的平均時間為15.29天,明顯縮短,具有統(tǒng)計學(xué)意義。SIB-IMRT和3DCRT組治療前后MMSE評分無顯著差異,分層分析1-2個腦轉(zhuǎn)移灶病例SIB-IMRT組3個月后有下降趨勢,6個月后恢復(fù),而3DCRT組治療后呈持續(xù)下降的走向;3-5個轉(zhuǎn)移灶病例兩組均呈上升走向,無顯著差異。SIB-IMRT組ADL評分治療前與治療1月后具有統(tǒng)計學(xué)差異(t=-2.459,P=0.017);3DCRT組治療前后ADL評分無顯著差異;分層分析無論1-2個轉(zhuǎn)移灶或3-5個,SIB-IMRT組1月后有上升走向,3個月有下降趨勢,6個月后恢復(fù);1-2個轉(zhuǎn)移灶3DCRT組治療后呈不斷下降走向,3-5個轉(zhuǎn)移灶3DCRT組治療后呈升高走向。SIB-IMRT與單純WBRT組在中樞神經(jīng)系統(tǒng)急性毒副反應(yīng)發(fā)生率差異有統(tǒng)計學(xué)差異(P=0.019),但與3DCRT組及單純腦轉(zhuǎn)移灶放療組相比無統(tǒng)計學(xué)差異。結(jié)論SIB-IMRT技術(shù)安全、有效,未發(fā)現(xiàn)明顯認知功能和生活能力改變,急性毒副反應(yīng)可耐受,顯著縮短放療時間,為患者爭取其它治療時間。
[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.
【學(xué)位授予單位】：貴州醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734.2

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