| Objective: This study was done to provide help for clinical treatment by analyzing the prognostic factors and the influence of dose and methods of radiotherapy on the survival rate of patients with brain metastases (BM) from lung cancer.Methods: 180 patients who were diagnosed for brain metastasis from lung primary cancer by CT or MRI scanning, underwent whole-brain radiation therapy (WBRT) only or boost dose at the Fourth Hospital of Hebei Medical University from May 2002 to March 2008 were ananlyzed. A number of potiential influ- enceing factors which might affect prognosis were evaluated, including pretreatment and treatment-related variables, that is gender, age, pathological type, control of primary tumor, internal from diagnosis lung cancer to the development of BM, number of BM, total volume of metastastic tumor and maximal volume of metastastic tumor, absence or presence of extracranial metastases, location of primary tumor, nervous systerm symptoms, technology of radiotherapy, dose of WBRT, total dose of radiotherapy, WBRT only or boost dose, dose-fraction mode. Survival time was recorded from BM diagnosed to die or final follow-up. Survival rate was calculated by Kaplan-Meier method. Log-rank method was adopted to compare the difference of each inferior group in survival rate. The multivariate ananlysis about survival was performed with Cox's regression propor- tional model. Statistical significance was defined as P < 0.05.Results: (1) For all patients, median survival time from BM diagnosed was 8 months, 1-year and 2-year survival rates were 29.47% and 8.99% respectively. (2) Median survival time were 9 months for male patients, 8 months for female patients, 1-year and 2-year survival rate were 29.60%, 6.83% for the male patients, and that were 29.91%, 16.57% for female patients respectively. The gender was not related to their prognosis (P =0.68). (3) 1-year and 2-year survival rate were 28.56%, 10.24% for the patients whose age was≤60, and 30.87%, 8.05% for the patients whose age was > 60. There was no diff- erence between two groups (P=0.86) in survival rate.(4) Median survival time were 13 months for squamous carcinoma, 8 mon- ths for adenocarcinoma and 8 months for small cell carcinoma. The difference of median survival time among 3 subgroups has no stasistical signifance (P=0.10). (5) 1-year and 2-year survival rates were 26.63% and 9.21% for the patients with primary lung tumor controlled, 30.44% and 8.72% for the patients with pri- mary lung tumor not controlled. Control of primary tumor has no influence on prognosis (P=0.50). (6) Internal from diagnosis lung cancer to the development of BM was not related to patients′prognosis (P=0.82). (7) 1-year and 2-year survival rate were significant better in patients who had from 1 to 2 meta- stases than patients who had > 2 metastases. The difference of survival rate between two groups was significant (P=0.04). (8) The overall volume and maximal volume of metastatic tumor were not related to prognisis. (9) Median survival times were 10 months for patients with only cranial metastasis, 8 months for patients with extercranial metastasis. The difference of survival time was significant (P=0.05). The absence or presence exter- cranial metastasis was related to survival. (10)Median survival time, 1-year and 2-year survival rate were 11 months, 37.25% and 14.37% for the patients with BM from left lung carcinoma, higher than 7 months, 20.93% and 4.09% for the patients with BM from right lung carcinoma. The difference of survival rate between two subgroups was significant (P=0.002). Cox multi- variate analysis indicated that the location of lung carcinoma was an indepented prognostic factor for the patients with brain metastase from lung cancer. (11) The absence or presence nerv- ous systerm symptoms were not related to prognosis. (12) The difference of survival time between convential radiotherapy and 3-dimensional conformal radiation therapy (3-DCRT) was not significant. The technology of radiotherapy was not related to prognisis (P=0.23). (13) 1-year and 2-year survival rate were 20.83% and 4.17% for the patients with the dose of WBRT≤32Gy, 33.41% and 11.43% for the patients with the dose of WBRT > 32Gy. The difference of survival rate between two group was significant (P=0.03). Cox multivariate analysis showed that the dose of WBRT was an indepent prognositic fac- tor for the patients with BM from lung cancer (P=0.04). (14) Median survival time were 7 months for the patients with the total dose of radiotherapy≤40Gy, 10 months for the patients with the total dose of radiotherapy 40Gy~50Gy, 9 months for the patients with the total dose of radiotherapy≥50Gy. The difference of median survival time among 3 subgroups was not significant (P=0.26). The total dose of radiotherapy has no in- fluence to prognosis for the patients with BM from lung cancer. (15) The difference of survival rate between WBRT only and local shrink yield increase dose was not significant (P=0.80). Boost dose or not was not influence prognosis for the patients with BM from lung cancer. (16) The survival time for the pati- ents received WBRT dose of 2.5Gy/37.5Gy, longer than WBRT dose of 3.0Gy/30Gy and WBRT dose of 2.0Gy/40Gy. Moreover the difference is significant (P=0.02). The dose-fraction model was related to the prognosis.Conclusion: The patients with primary tumor from left lung, received WBRT dose of 32Gy have longer survival time and they could benefit from treatment.
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