- 期刊
Palliative Radiotherapy for Synchronous Brain Metastases from Lung Cancer
同時發現的肺癌合併腦轉移的緩解性放射治療
摘要
目的：在初診斷肺癌時若同時合併腦轉移，則表示已經是第四期的肺癌，存活時問也比較有限。對於此種病人的治療，是以減輕病人的痛苦為主要目的。本文分析此種病人接受緩解性放射治療的結果並評估其療效。 材料與方法：本科從西元1987年至1994年，總共有102位病人在初診斷肺癌時即同時合併有腦部電腦斷層證實的腦轉移。這102位病人都有接受dexamethasone治療及腦部放射治療（放射劑量中間值是30 Gy）。其中有30位病人也有接受肺部放射治療。另外分別有14位病人接受化學治療，9位病人接受腦部手術治療。 結果：腦轉移最常見的神經症狀是無力(67.6%)及頭痛(55.9%)。腦部放射治療平均為期15.2天。74.3%的病人在治療後其神經症狀有改善。存活時間的中問值是4.2個月，一年存活率是14.7%。多變項存活分析的結果顯示良好的活動狀態、較高的腦部放射劑量、有接受腦部手術治療、沒有大小便失禁等四個變數為良好的預後因子。 結論：因為肺癌同時合併腦轉移病人的存活時間有限，而且其神經症狀也相當不適；良好的姑息性治療以改善生活品質是非常重要的。由本文結果發現腦部放射治療可以減輕74.3%病人的神經症狀，而且其平均為期只有15.2天；所以放射治療是很好的緩解性治療。肺部放射治療對於存活並沒有顯著的影響，其角色主要在緩解病人的肺部症狀。
並列摘要
Purpose: Synchronous brain metastases (SM) of lung cancer patients indicate advanced stage and limited survival. The treatment intent is to relieve the agonizing symptoms. We analyzed the results of radiotherapy for these patients to evaluate the effects of palliative treatment. Materials and Methods: From 1987 to 1994, 102 lung cancer patients with CT-documented synchronous SM were reviewed. All patients received cranial irradiation (median dose 30 Gy) and dexamethasone. Chemotherapy and neurosurgery were performed in 14 and 9 cases respectively. Thirty patients also underwent lung irradiation. Results: The two leading neurological symptoms were motor weakness (67.6%) and headache (55.9%). The mean duration of cranial irradiation was 15.2 days. After treatment, overall neurological symptomatic response rate was 74.3%. Median survival was 4.2 months and 1-year survival rate was 14.7%. The multivariate survival analysis showed that good performance status, higher total cranial radiation dose, neurosurgery, and absence of urine/stool incontinence were favorable prognostic factors. Conclusions: Owing to short life expectancy and neurological morbidity of lung cancer patients with synchronous SM, a good palliative treatment to improve life quality is required in supportive care of these patients. Radiotherapy appears as an effective means of palliation with 74.3% neurological symptomatic response rate while the median duration of cranial irradiation is only 15 days. Lung irradiation has no significant effect on survival; instead, it should be used for palliation of symptoms.