Analysis Of Radiotherapy For 197 Cases Of Brain Metastases From Non-small Cell Lung

Objective:Radiotherapy is the major treatment modality for brain metastasesofmalignanttumor.Thecurrentstudyretrospective analysis the clinical records of brain metastases with primary non-small cell lung cancer(NSCLC)treated with whole brain radiotherapy(WBRT),fractionated stereotacticradiotherapy(FSRT),whole brain radiotherapy followed by sequential boost(WBRT+boost),whole brain radiotherapy followed by FSRT(WBRT+FSRT)and simultaneous integrated boost(SIB),Explore the efficacy of different treatments options and the factors that affect the survival of patients.Method:Retrospective analysis of NSCLC patients with brain metastases who received brain radiation treatment between Jan 1~stt 2012 and Dec 31 2016in Sichuan Cancer Hospital.The inclusion criteria are:1)>18 years old;2)Karnofky performance score(KPS)≥60;3)with NSCLC pathology diagnosis;4)has brain Magnetic Resonance Imaging(MRI)showing measurable metastases before radiation;5)without previous surgery or radiotherapy at brain;6)completed scheduled radiotherapy;7)with full followup;8)consent form signed before radiotherapy.The clinical characteristics,treatment planning,outcome,and toxicity of treatment were collected.Results:A total of 197 patients were finally included.Among the 197patients,80 cases received SIB,18 cases received FSRT,33 cases received WBRT+FSRT,41 cases received WBRT+boost,25 cases received WBRT.The ages are 18 years to 83 years(median 58 years).Numbers of brain metastases are 1 to Countless(Take 10 as a reference value)(median 3).The survival time are 1 months to 79 months(median 15 months).Evaluation of recent efficacy of patients with MRI(1-3 months after radiotherapy completed),number of patients for complete response(CR),partial response(PR),stable disease(SD),progression disease(PD),and calculated objective response ratio(ORR)are:SIB group:14,29,31,6,53.75%;FSRT group:4,6,6,2,55.56%;WBRT+FSRT group:3,15,11,4,54.55%;WBRT+boost group:4,18,16,3,53.66%;WBRT group:6,4,14,1,40%.Median survival time for all patients were 15 months,The median survival time of SIB,FSRT,WBRT+FSRT,WBRT+boost,WBRT group were 17,19,22,17,8 months,respectively.The toxicities were all acceptable for five groups.Considering the dose of whole brain,SIB group and WBRT group have significant higher biological effective dose(BED)than WBRT+FSRT group and WBRT+boost group,which may cause more serious changes in the quality of life such as cognitive dysfunction and emotions.In the multivariat analysis,it is proved that age,pathology,GPA score,pulmonary surgery,targeted therapy,craniocerebral radiotherapy,target dose are independent factors that associated with prognosis.Conclusion:Whole brain radiotherapy,whole brain radiotherapy followed by sequential boost,whole brain radiotherapy followed by FSRT,Simutaneous integrated boost,fractionated stereotactic radiotherapy all are effective treatments for non-small cell lung cancer with brain metastases.The multivariate analysis showed that age,pathology,GPA score,pulmonary surgery,targeted therapy,craniocerebral radiotherapy,target dose are independent factors that associated with prognosis.There is no difference in early efficacy among five groups.However,in the long term followup,WBRT was found to have the shortest overall survival.The brain BED of SIB group and WBRT group are significant higher than WBRT+FSRT group and WBRT+boost group,although the acute toxicity score showed no difference among all groups.