| Objective: To investigate the clinical efficacy of whole-brain combined with local simultaneous push radiotherapy in the treatment of NSCLC patients with brain metastasis,and to analyze the related prognostic factors,so as to provide basis for clinical diagnosis and treatment.Methods : Retrospective analysis was performed on the patients who visited the affiliated Tumor Hospital of Guangxi Medical University from November 2013 to November 2017 and received whole-brain radiotherapy alone or whole-brain combined with local synchronous push-out radiotherapy for NSCLC brain metastasis,who were pathologically diagnosed as non-small cell lung cancer.A total of 134 patients with brain metastasis indicated by cranial MRI were selected as study subjects.According to different radiotherapy methods,the patients were divided into two groups,namely group A: 65 patients received whole-brain radiotherapy,and group B: 69 patients received wholebrain combined with local synchronous push-out radiotherapy.The whole brain radiotherapy group(65 cases): Whole brain 30Gy/ 10 F / 2W(3Gy/ F);the whole brain combined with local synchronous radiation treatment group(69cases): whole brain 37.8-39.6Gy/ 18 F / 3W +(2.10-2.2Gy/ F)simultaneously with brain metastatic tumor 52.2-54Gy/ 18 F / 3W +(2.9-3.0Gy/ F).SPSS 23.0software was used for statistical analysis.When P < 0.05,the difference was considered to be statistically significant.Then,OS,i PFS,6-month,1-year and 2-year intracranial progression-free survival rate,survival rate,i ORR,i DCR and acute radiation injury were observed and compared,and prognostic factors were analyzed.According to the data of this study,the lesions of all patients were divided into 1-5 and 5 lesions of > for subgroup analysis of OS and acute radiation injury.Subgroup 1: the number of lesions ≤5,and subgroup 2: the number of lesions > 5.Results:(1)To observe the comparison of gender,age,KPS score before radiotherapy,neurological symptoms before radiotherapy,craniocerebral organ metastasis,number and size of brain lesions,pathological type,T stage,N stage,use of targeted drugs and initial treatment of patients in the two groups,the P values were all P > 0.05.The clinical characteristics between the two groups were comparable.(2)The short-term objective efficacy evaluation showed that the effective rate(CR+PR)and the clinical benefit rate(CR+PR+SD)in group A were 21.6% and 83.1% respectively.In group B,the effective rate(CR+PR)was50.7% and the clinical benefit rate(CR+PR+SD)was 97.1%.IORR and i DCR of group B were better than that of group A(i ORR:P < 0.001).IDCR:P=0.006).(3)The median OS in group A and Group B was 19 months and 26 months,respectively;the median i PFS was 25 months and 29 months,respectively;the median OS and i PFS in group B were both longer than those in group A.The 6-month survival rates of group A and Group B were 89.7% and 88.9%,respectively(2=0.018,P=0.894),and the 6-month progression-free intracranial survival rates were 65.6% and 78.1%,respectively(P=0.317).The 1-year survival rates were 62.1% and 81.0%(P=0.045),and the 1-year progression-free survival rates were 40.6% and 60.9%(P=0.048),respectively.The 2-year survival rates were 25.9% and 57.1%(P=0.005),and the 2-year progression-free survival rates were 9.4% and 34.4%(P < 0.001),respectively.The 6-month survival rate and intracranial progression-free survival rate in group A and Group B were not statistically significant(PA=0.894,PB=0.317).The 1-year and 2-year survival rates and intracranial progression-free survival rates in group B were higher than those in group A.(4)Univariate analysis showed that age,CNS symptoms before radiotherapy,radiotherapy mode,number of brain lesions,and KPS score after radiotherapy were correlated with patients’ OS,while age,CNS symptoms before radiotherapy,radiotherapy mode,targeted drug use,and KPS score after radiotherapy were correlated with patients’ i PFS.Multivariate analysis showed that age,neurological symptoms before radiotherapy,radiotherapy mode,and number of brain lesions were independent prognostic factors for OS.Radiotherapy is an independent prognostic factor for i PFS.(5)The radiotherapy plan of the whole group of patients can make the target dose distribution of all patients meet the requirements and meet the requirements of the tolerated dose of normal tissue.The results of acute radiation injury showed that there was no statistically significant difference in the incidence of acute radiation injury between group A and Group B: the incidence of grade 3 reaction in group A and B was 1.5% and 2.9%,respectively(P=0.655);the incidence of grade 4 reaction in group A and B was 1.5% and1.4%,respectively(P=0.564).(6)Results of OS and acute radiation injury with the number of lesions ≤5 and the number of lesions > : 1)OS of the groups ≤5:the 6-month,1-year and 2-year survival rates of group B were all higher than that of group A;the 1-year and 2-year survival rates of the two groups were statistically significant(P < 0.05),while the 6-month survival rates of the two groups were not statistically significant(P > 0.05).2)The results of OS in the five groups of > lesions: OS: there were no statistically significant differences in the 6-month,1-year and 2-year survival rates between group A and group B(P >0.05).3)There was no statistically significant difference in the incidence of acute radiation injury between the five groups with the number of lesions ≤5and the five groups with the number of lesions >.Among the five groups with the number of lesions,the incidence of grade 3-4 reactions in group A and group B was 3.2% and 4.8%,respectively(P=1.000).The rate of grade 3-4 reaction in group A and group B was 3.7% and 4.8%(P=1.000),respectively.Conclusion: 1.The short-term efficacy of whole brain combined with local synchronous radiotherapy for NSCLC patients with brain metastases is accurate,and the survival rate of MST,1-year and 2-year and progression-free intracranial survival rate of whole brain combined with local synchronous radiotherapy are higher than that of whole brain radiotherapy group.The patient has a good tolerance,which is a feasible treatment method for NSCLC brain metastatic tumor.2.Multivariate analysis showed that age,CNS symptoms before radiotherapy,radiotherapy mode,and number of brain lesions were independent prognostic factors for OS.Radiotherapy is an independent prognostic factor for i PFS.3.Whole-brain combined with local simultaneous radiotherapy for brain metastatic tumors with the number of brain metastases ≤5 in NSCLC increased OS by 2 years without increasing acute radioactive brain injury. |
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