本文選題：預(yù)后因素　切入點(diǎn)：腦轉(zhuǎn)移　出處：《浙江大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：本研究旨在探討接受全腦放療(WBRT)為基礎(chǔ)的綜合治療的非小細(xì)胞肺癌腦轉(zhuǎn)移患者的預(yù)后因素以及腦轉(zhuǎn)移瘤放療后影響其局部療效的相關(guān)因素。 材料和方法：本研究入組了135例接受全腦放療的非小細(xì)胞肺癌腦轉(zhuǎn)移患者,其中47(34.8%)例接受了加量放療,84(62.2%)例接受了全身化療,39(28.9%)例接受了表皮生長(zhǎng)因子受體酪氨酸激酶抑制劑(EGFR-TKIs)治療,對(duì)其預(yù)后影響因素進(jìn)行分析。并對(duì)其中有頭顱MRI隨訪資料的患者針對(duì)其腦轉(zhuǎn)移瘤放療后反應(yīng)(56例患者,235個(gè)腦轉(zhuǎn)移瘤)及局部控制率(60例患者,245個(gè)腦轉(zhuǎn)移瘤)的潛在影響因素進(jìn)行分析。 結(jié)果：全組患者的中位總生存期為9.3個(gè)月,1年和2年總生存率分別為46.3%和16.1%。單因素分析提示“年齡60歲”、“無顱外轉(zhuǎn)移”、“KPS≥70分”、“診斷腦轉(zhuǎn)移后化療數(shù)≥3周期”、“聯(lián)合EGFR-TKIs治療”、“無小腦轉(zhuǎn)移”與預(yù)后良好密切相關(guān)。多因素分析提示“無顱外轉(zhuǎn)移”、“KPS≥70分”、“診斷腦轉(zhuǎn)移后化療數(shù)≥3周期”、“接受EGFR-TKIs治療”、“無小腦轉(zhuǎn)移”是預(yù)后良好的獨(dú)立影響因素。對(duì)其中58例存在1-3個(gè)腦轉(zhuǎn)移灶的患者進(jìn)行亞組分析發(fā)現(xiàn),全腦放療聯(lián)合加量放療與預(yù)后良好密切相關(guān)。60例有頭顱MRI隨訪資料的患者(共245個(gè)腦轉(zhuǎn)移瘤)的中位隨訪時(shí)間6.1月(1-21.8月),其中進(jìn)入放療反應(yīng)分析的235個(gè)腦轉(zhuǎn)移瘤放療后三個(gè)月總反應(yīng)率62.6%,全組245個(gè)腦轉(zhuǎn)移瘤的6個(gè)月局部控制率88.9%,1年的局部控制率70.2%。單因素分析提示“女性”、“腺癌”、“KPS70",“腦轉(zhuǎn)移瘤最大徑≤1cm"、“MRI中腦轉(zhuǎn)移瘤實(shí)性強(qiáng)化”、“放療后3月內(nèi)化療數(shù)≥2周期”與腦轉(zhuǎn)移瘤放療后容易出現(xiàn)近期反應(yīng)密切相關(guān),“腺癌”、“KPS70分”、“腦轉(zhuǎn)移瘤最大徑≤1cm”、“放療后無進(jìn)展期間化療數(shù)≥3周期”與腦轉(zhuǎn)移瘤放療后局部控制良好密切相關(guān)。多因素分析提示“腺癌”、“增強(qiáng)MRI中腦轉(zhuǎn)移瘤實(shí)性強(qiáng)化”、“放療后3月內(nèi)化療≥2周期”是腦轉(zhuǎn)移瘤容易出現(xiàn)放療后反應(yīng)的獨(dú)立影響因素,同時(shí)“腦轉(zhuǎn)移瘤最大徑≤1cm”、“放療后無進(jìn)展期內(nèi)化療數(shù)≥3周期”是放療后腦轉(zhuǎn)移瘤局部控制良好的獨(dú)立影響因素。 結(jié)論：我們不但驗(yàn)證了以往報(bào)道的預(yù)后因素,而且在我們的研究中發(fā)現(xiàn)無小腦轉(zhuǎn)移是預(yù)后良好的獨(dú)立影響因素。同時(shí)我們發(fā)現(xiàn)病理、腦轉(zhuǎn)移瘤性質(zhì)、化療是影響腦轉(zhuǎn)移瘤放療后反應(yīng)的獨(dú)立影響因素。腦轉(zhuǎn)移瘤大小和化療是腦轉(zhuǎn)移放療后局部控制的獨(dú)立影響因素。
[Abstract]:Objective: to investigate the prognostic factors of patients with brain metastases from non-small cell lung cancer (NSCLC) treated with WBRT-based whole brain radiotherapy (WBRT) and the factors related to the local efficacy of brain metastases after radiotherapy. Materials and methods: 135 patients with brain metastases from non-small cell lung cancer receiving whole brain radiotherapy were enrolled in this study. Among them, 47 / 34.8) received additional radiotherapy (84 / 62.2) and systemic chemotherapy (3928.9) / EGFR-TKIs. the epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKIs) was used. The prognostic factors were analyzed, and the potential of 56 patients with brain metastases, 235 brain metastases, and 60 patients with local control rate and 245 brain metastases were analyzed in the patients with cranial MRI follow-up data (56 patients with brain metastases after radiotherapy, 235 patients with brain metastases) and 60 patients with local control rate (60 patients with brain metastases) and 245 patients with brain metastases (n = 245). The influencing factors were analyzed. Results: the median total survival time was 9. 3 months, and the overall 1 year and 2 year survival rates were 46.3% and 16. 1 respectively. Univariate analysis showed that "age 60", "no extracranial metastasis", "KPS 鈮，

本文編號(hào)：1598251