The Curative Effect Comparison Of Simultaneous Integrated Boost Conformal Radiotherapy Versus Whole Brain Radiotherapy With Local Sequential Conformal Radiotherapy In The Treatment Of Nsclc Patients With One To Three Brain Metastatic Tumors

Objective:To compare the short-term effects,median survival time,half year survival rate,one year survival rate and two year survival rate of simultaneous integrated boost conformal radiotherapy(SIB-CRT) versus whole brain radiotherapy with local sequential conformal radiotherapy(WBRT+CRT) in the cerebral radiation of patients with one to three brain metastatic tumors from non-small cell lung cancer.To compare the target volume rate,hospitalization time,occurrence rate of acute and late injury caused by radiation.Methods:Sixty five patients with one to three brain metastatic tumors from NSCLC confirmed by enhanced MRI were prospectivery collected in this retrospective study,who were treated in The tumor hospital of Guangxi Medical Universtity from January,2010 to June,2015.According to the types of brain radiotherapy,thirty two patients in SIB-CRT group were given the dose of radiotherapy:6MV-X ray,38.7Gy/18f/3w+(2.15Gy/f) for the whole brain and 52.2Gy/18f/3w+(2.9Gy/f) for the brain metastatic tumors at the same time. Thirty three patients in WBRT+CRT group were given the dose of radiotherapy:6MV-X ray,30Gy/10f/2w(3Gy/f) for the whole brain and then 21Gy/7f/lw+(3Gy/f) for the brain metastatic tumors,or 40Gy/20f/4w(2Gy/f) for the whole brain and then 20Gy/10f/2w(2Gy/f) for the brain metastatic tumors.To record all patients’infromation such as age,sex,KPS,pathological pattern,TNM phase,the number and size of brain metastatic tumors,the situation of the extracranial organ metastases,GPA score of lung cancer,the change of neurological symptoms,the cerebral radiation dose,the hospitalization time,target volume rate,the occurrence of acute and late injury caused by radiation,overall survival.To analyse in SPSS 16.0 software and the difference was statistically significant when the P value was lesser than 0.05.Results:(1)The comparison of clinical features between two groups such as age,sex,KPS,patho logical patterns, the situation of neurological symptoms,TNM phase,the number of brain metastatic tumors,the situation of the extracranial organ metastases and GPA score had no statistical difference.(2)The number of CR,PR,SD,PD in SIB-CRT group were 6,19,7,0 respectively, in WBRT+CRT group were 2,13,12,6.The objective remission rate of two groups were 78.1% and 45.5% respectively(P<0.05).The disease control rate of two groups were 100% and 81.8% respectively(P<0.05).The short-term effects of SIB-CRT group was better than WBRT+CRT group in one months after the brain radiation.(3)The median survival time of SIB-CRT group was longer than WBRT+CRT group(17.0 months vs 11.0 months,P=0.014).(4)The half year,one year and two year survival rate in SIB-CRT group were 93.8%,67.8% and 32.1% respectively,in WBRT+CRT group were 75.8%,48.5%,9.7%.The survival rate of SIB-CRT group were better than WBRT+CRT group(P=0.014).(5)Multivariate analysis showed that the GPA score and cerebral radiation technology were the prognosis factors of patients with brain metastatic tumors from NSCLC.(6)The target volume rate of the SIB-CRT group was better than the WBRT+CRT group(96.80±2.52% vs 89.18±3.28%,P=0.000).(7)The hospitalization time between two groups didn’t have statistical difference(26.53±3.55days vs 28.94±7.15days,P=0.091).(8)The number of 0-1,2,3,4 grades of acute injury caused by radiation in SIB-CRT group were 12,18,2,0 respectively, in WBRT+CRT group were 16,15,2,0. There was no statistics difference between two groups(P=0.660).(9)There were 25 patients in SIB-CRT group and 21 patients in WBRT+CRT group still alive in half year after brain radiation. The number of 0-2,3,4,5 grades of late injury caused by radiation in SIB-CRT group were 21,3,1,0 respectively, in WBRT+CRT group were 18,3,0,0. There was no statistics difference between two groups(P=1.000).Conclusion.The SIB-CRT group was better than the WBRT+CRT group in the short-term effects,MST,half year survival rate,one year survival rate and two year survival rate.Multivariate analysis showed that the GPA score and cerebral radiation technology were the prognosis factors.The target volume rate of the SIB-CRT group was better than the WBRT+CRT group,but the hospitalization time, the occurrence rate of acute and late injury caused by radiation between two groups didn’t have statistical difference. According to this study,we suggest to choose the technology of SIB-CRT in the cerebral radiation of patients with one to three brain metastatic tumors from NSCLC.