A Retrospective Study Of Patients With Brain Metastases From Lung Cancer Treated With Gamma Knife

Objective:Objective:To provide a reference for the clinical application of Gamma Knife in patients with brain metastases from lung cancer,the clinical data of patients were collected and disease characteristics,treatment options and the efficacy were analyzed.Methods:(1)Objects:Patients with brain metastases from lung cancer who were firstly received Gamma Knife from February 2009 to August 2016 in a certain grade-three general hospital.(2)Research contents:the basic conditions,disease characteristics,treatment status,outcomes,short-term efficacy,adverse reactions,and laboratory tests of patients were all analyzed.(3)Statistical analysis:Epidata3.1 and SPSS21.0 were used for data entry,collation and analysis.The ?~2 test or rank sum test was used to analyze the disease characteristics,outcomes,short-term efficacy and adverse reactions of patients.The rank sum test was utilized to analyze the changes of tumor biomarkers and laboratory tests in patients before and after treatment;Logistic regression was applied to analyze the factors affecting the outcomes of brain metastases from lung cancer.Results:(1)The basic conditions of patients with brain metastases from lung cancer:among 279 patients,196 were males,accounting for 70.3%;83 were females,accounting for 29.7%.The minimum age was 28 years and the maximum age was 83years.The median age was 58(51,66)years old.For the pathological types of primary lesions,adenocarcinomas accounting for 65.2%,small cell carcinomas accounting for 14.4%,squamous carcinomas accounting for 13.8%,adenosquamous carcinoma and large cell carcinoma,accounting for 3.3%.The shortest time for brain metastases was 1(0,12)months.Of all the 604 known brain metastatic lesions,450cases were brain lobar lesions,accounting for 74.5%,108 were other extracerebral system metastases,accounting for 38.7%.(2)The disease characteristics of patients with brain metastases from lung cancer:the occurrence of brain metastases was influenced by whether the primary lung lesion was controlled(Z=-10.665,P<0.001).Treatment of primary lung lesions could delay the occurrence of brain metastases(Z=-10.665,P<0.001).Clinical symptoms changed correspondingly following the distribution of brain metastases(?~2=19.685,P=0.001).Focal nerve localization in patients whose metastases located in the brain lobe are more prominent than those in the cerebellum(?~2=7.397,P=0.007).(3)The outcomes of patients with brain metastases from lung cancer:the outcomes of improved was accounting for 76.7%.Numbers of brain metastases lesions had an impact on the outcomes of patients(?~2=14.687,P=0.001).The status of cerebral metastases made a significant difference to the outcome of patients(?~2=3.954,P=0.047).Patients with cerebral metastases tended to have a poor outcome after treatment.The cumulative dose could also impact the prognosis of patients(?~2=5.616,P=0.018).Patients with the cumulative dose level greater than or equal to 3000cGy appeared to have a relatively favorable prognosis.As revealed by multiple factor analysis,the improvement rate of patients with?4lesions was 0.487 time than those with just one lesion(Wald-?~2=4.176,P=0.041,OR=0.487).(4)The short-term effects of patients with brain metastases from lung cancer:Among the patients with follow-up data,complete remission(CR)of their disease was accounting for 16.2%;partial remission(PR)was accounting for 32.4%;no significant changes(SD),was accounting for 29.8%and progressive Disease(PD)was accounting for 21.6%.The overall local control rate was 78.4%.The overall effective rate was 48.6%.Basic conditions,primary lung lesions,brain metastases,extracerebral metastases,and treatment regimen had no effect on the short-term efficacy of the patients(P>0.05).(5)Tumor markers of patients with brain metastases from lung cancer:the level of CA125 of patients was elevated after treatment(Z=-2.053,P=0.040).Man,and no extracranial metastases were the influencing factors which related to the elevated CA125(P<0.05).Cytokeratin fragment 19(CYFRA21-1)was elevated(Z=-2.461,P=0.014)after treatment.(6)Adverse reactions in patients with brain metastases from lung cancer:adverse reactions was accounting for 24.4%,paients didn't have adverse reactions was accounting for 75.6%.The history of hypertension had an effect on adverse reactions in patients(P=0.040).The incidence of adverse reactions was higher in patients with a history of hypertension.The number of treatments and dose per fraction had no effect on adverse reactions in patients(P>0.05).Adverse reactions made no difference in the short-term effects(P=0.693).(7)Laboratory examination in patients with brain metastases from lung cancer:there was a statistically significant difference in platelet before and after treatment(Z=-2.427,P=0.015)and proper treatments could make it decrease.Conclusion:(1)Focal nerve localization in patients whose metastases located in the brain lobe are more prominent than those in the cerebellum.(2)Controlling primary lung lesions could delay the occurrence of brain metastases.(3)The number of lesions was an independent factor for outcomes of patients with brain metastases from lung cancer after Gamma Knife treatment.(4)Sex and extracranial metastases were the influencing factors which related to the CA125,KPS were the influencing factors which related to the CYFRA21-1.