本文選題：腦轉移瘤　切入點：全腦放射治療　出處：《河南科技大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:中樞神經(jīng)系統(tǒng)轉移瘤(腦轉移瘤)是成年人出現(xiàn)顱內腫瘤的最常見形式。25%-35%的惡性腫瘤可發(fā)生腦轉移。根據(jù)美國國立綜合癌癥網(wǎng)絡最新更新的中樞神經(jīng)系統(tǒng)腫瘤臨床實踐指南中,對于中樞神經(jīng)系統(tǒng)腫瘤的治療,特別是對于不能手術的患者,放療是最重要的一種治療方式。本研究的研究目的是評價腦轉移瘤患者給予全腦放射治療或立體定向放療或給予兩者聯(lián)合放療后,對總生存期及生活質量的影響,為患者選擇最佳的治療方案提供循證學依據(jù)。方法:根據(jù)研究目的制定檢索式,在各大數(shù)據(jù)庫中搜索關于全腦放射治療或立體定向放療或兩者聯(lián)合放療療效的相關臨床研究,根據(jù)納入排除標準選擇納入文獻,提取數(shù)據(jù)并采取RevMan5.0軟件對研究數(shù)據(jù)進行Meta分析。結果:最終有31篇文獻可納入本研究,共24695名患者;Meta分析結果示:(1)立體定向放療與全腦放療相比:全腦放療增加患者死亡風險HR=1.63(95%CI 1.34-1.99,P0.00001),而對于1-3個腦轉移灶患者,兩種放療計劃并無明顯差別HR=1.48(95%CI 0.89-2.43,P=0.130);行全腦放療的患者腦轉移灶的局部控制率降低HR=2.06(95%CI 1.24-3.43,P=0.006);兩者3級以上的放療毒性無明顯差別OR=1.84(95%CI 0.75-4.51,P=0.180)。(2)聯(lián)合放療與全腦放療相比:聯(lián)合放療可明顯提高患者的總生存期HR=0.78(95%CI 0.70-0.87,P0.0001),及1-3個腦轉移瘤患者的生存期HR=0.82(95%CI 0.70-0.95,P=0.009),聯(lián)合放療提高局部控制率HR=0.30(95%CI 0.20-0.44,P0.00001);聯(lián)合放療并未增加患者的2級以上放療相關毒副反應發(fā)生率:急性毒副反應OR=0.74(95%CI 0.45-1.21,P=0.230),晚期毒副反應OR=1.25(95%CI 0.58-2.72,P=0.570)。(3)聯(lián)合放療與立體定向放療相比:兩種放療計劃對于所有患者,及1-3個腦轉移灶患者總生存期的影響并無明顯差別:HR=0.96(95%CI 0.88-1.06,P=0.420),HR=0.96(95%CI 0.84-1.10,P=0.570);腫瘤控制率方面,聯(lián)合放療對局部控制率有明顯優(yōu)勢HR=0.82(95%CI 0.69-0.97,P=0.020),而患者遠處控制率及總控制率無明顯差別HR=0.89(95%CI 0.72-1.09,P=0.260);而在1-3個腦轉移灶的患者群中,局部控制率無明顯差別:HR=1.01(95%CI 0.77-1.32,P=0.960),HR=1.09(95%CI 0.80-1.49,P=0.580);兩種放療計劃的2級以上放療毒性無明顯差別OR=1.18(95%CI 0.78-1.79,P=0.440)。結論:三種放療方案中,聯(lián)合放療對患者的總生存期及局部控制率有較明顯優(yōu)勢,腦轉移瘤的數(shù)量并不是絕對的限制條件;立體定向放療與全腦放療相比,立體定向放療的優(yōu)勢更加突出,可明顯提高患者的總生存期及局部控制率;放療相關毒副反應方面,彼此之間并無明顯差別,聯(lián)合放療并未提高放療毒副反應。
[Abstract]:Objective: central nervous system metastasis (CNS) is the most common form of intracranial tumors in adults. In the guidelines for Clinical practice in Cancer, For the treatment of central nervous system tumors, especially for patients who cannot be operated on, Radiotherapy is one of the most important treatment methods. The purpose of this study was to evaluate the effects of whole-brain radiotherapy or stereotactic radiotherapy or combined radiotherapy on the overall survival and quality of life in patients with brain metastases. Methods: according to the objective of the study, a search formula was developed to search for the clinical studies on the effects of global brain radiotherapy or stereotactic radiotherapy or combined radiotherapy. According to the inclusion exclusion criteria, we selected the inclusion literature, extracted the data and analyzed the research data with RevMan5.0 software. Results: finally, 31 articles could be included in this study. A meta-analysis of 24695 patients showed that stereotactic radiotherapy increased the risk of death in patients with HR=1.63(95%CI 1.34-1.9ng P0.00001, compared with whole-brain radiotherapy, while in 1-3 patients with brain metastases. There was no significant difference between the two radiotherapy plans (HR=1.48(95%CI 0.89-2.43); the local control rate of brain metastases in patients undergoing whole-brain radiotherapy decreased HR=2.06(95%CI 1.24-3.43 P0.006; there was no significant difference in radiation toxicity between the two groups above grade 3 (OR=1.84(95%CI 0.75-4.51). The total survival time (HR=0.78(95%CI) of patients with brain metastases was increased significantly (HR=0.78(95%CI 0.70-0.87g P 0.0001g), the survival time of 1-3 patients with brain metastases was 0.70-0.95U P0.0009, and the local control rate of HR=0.30(95%CI 0.20-0.44mP0.00001n was improved by combined radiotherapy. The incidence of acute side effects associated with radiotherapy above grade 2 was not increased by combined radiotherapy. Side effects of OR=0.74(95%CI 0.45-1.21 OR=0.74(95%CI 0.230, late toxicity OR=1.25(95%CI 0.58-2.72PU 0.570. 3) combined radiotherapy compared with stereotactic radiotherapy: two radiotherapy plans for all patients, There was no significant difference in the overall survival time between 1-3 patients with brain metastases and those with CI 0.88-1.06Ph 0.420, CI 0.84-1.10P0.5700.The tumor control rate was significant. The local control rate of combined radiotherapy was significantly superior to that of HR=0.82(95%CI 0.69-0.97, while the distant control rate and the total control rate of the patients had no significant difference in HR=0.89(95%CI 0.72-1.09Pu 0.260, but in the patients with 1-3 brain metastases, there was no significant difference in the distance control rate and the total control rate, but in the group of 1-3 brain metastases, there was no significant difference between the two groups. There was no significant difference in local control rate between 1.01-95CI-0.77-1.32Pn0.9600.96. There was no significant difference in the toxicity of OR=1.18(95%CI 0.78-1.79 P0.440.400.Conclusion: the total survival time and local control rate of patients with combined radiotherapy were significantly superior. The number of brain metastases is not an absolute limitation. Stereotactic radiotherapy has more advantages than whole brain radiotherapy, which can significantly improve the overall survival time and local control rate of patients. There was no significant difference between the two groups, and combined radiotherapy did not increase the toxicity of radiotherapy.
【學位授予單位】：河南科技大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R739.4
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本文編號：1581400