Recent Radiotherapy Effect And Influence Factors To Survival In Lung Cancer Patients With Brain Metastases

Objective: 1.To analyze various factors which would affect the survival time of lung cancer patients with brain metastases who had brain radiotherapy.2.To investigate the clinical application of the grades of RPA.Methods: The clinical data of 153 lung cancer patients with brain metastases who had brain radiotherapy were retrospectively reviewed.To analyze the survival time influenced by age,gender,pathology,number of brian metastasis,history of smoking,symptom of brain metastases,visceral metastases of extracranium , chemotherapy , dosage of radiotherapy,recent effect of radiotherapy,re-radiotherapy, KPS and grade of RPA. The recent effect is judged by the RTOG(Radiation Therapy Oncology Group) brain tumor radiotherapy assessment standards.Whose nervous symptoms are complete remission is CR;partial remission is PR;stable disease is SD;progressive disease is PD. Recursive partitioning analysis(RPA)is stratified to three classes: Class 1: patients with KPS≥70, <65 years of age with controlled primary and no extracranial metastases; Class 3: KPS < 70; Class 2:all others. The remission rate is the percentage of CR and PR.The mean and median survival time are caculated by months from the day when brain metastases is diagnosed.Results: There are 153 patients in this research.Theχ~2test of remission rate of each subgroup suggest that chemotherapy,KPS and RPA grades have statistical significance. (χ~2is 7.289,56.624 and 58.294 respectively;P is 0.007,0.000 and 0.000 respectively).The overall survival time and median survival time were 14.5 and 10.3 months respectively.The survival rate of 1,2,3 and 5 years were 40%,14%,10% and 3%. Visceral metastases of extracranium, chemotherapy, re- radiotherapy and grade of RPA have statistical significances(χ~2are 5.630 , 4.739 , 7.025 and 9.138 respectively ;P are 0.018 , 0.029 , 0.008 and 0.003 respectively). Age,pathology and dosage of radiotherapy have tendency to statistical differences(χ~2are 3.566 , 2.759 , 2.747;P are 0.059 , 0.097 , 0.097). Sex,number of metastasis,smoking history,brain symptoms,effect of radiotherapy and KPS after radiotherapy have no statistical differences(χ~2are 2.440 , 1.233 , 1.489 , 1.583 , 0.351 , 1.782 respectively;P are 0.118 , 0.267 , 0.222 , 0.208, 0.554 , 0.182 respectively).Conclusions: We suggest young patients who are NSCLCs and whose RPAs are low , without extracranial visceral metastasis ,should take positive treatments,including sufficient dose of radiotherapy.And if normal conditions permitting, we also suggest the relapsing take re-radiotherapy in order to prolong the overall survival.The aggressive treatment of combination of the chemotherapy and radiotherapy is beneficial to enhance the remission rate and also prolong the survival.The practice of classification of RPA has clinical significance.