Radiation therapy for brain metastases from lung carcinoma. Prospective randomized trial according to the level of lactate dehydrogenase.
Radiation therapy for brain metastases from lung carcinoma. Prospective randomized trial according to the level of lactate dehydrogenase.
复制标题
肺癌脑转移的放射治疗。
DOI：
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发表时间：
1994
期刊：
影响因子：
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通讯作者：
T. Inoue
中科院分区：
文献类型：
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作者：
M. Chatani;Y. Matayoshi;N. Masaki;T. Inoue
目的
自1980年9月以来，我们一直在进行前瞻性随机试验，以确定肺癌脑转移放射治疗(XRT)的最佳治疗方案。第一个试验(1980年9月至1984年12月)按两种不同的时间剂量放射治疗方案随机分配，即30Gy10次/2周和50Gy20次/4周。治疗结果显示，两组在神经功能改善和生存方面无明显差异，乳酸脱氢酶(LDH)是最重要的预后因素。本研究(1985年1月至1992年4月)研究了两个按LDH水平分层的序贯试验，共纳入162例肺癌脑转移患者。
患者和方法
LDH正常组选择30Gy10次/2周(A组，n=46)或50Gy20次/4周(B组，n=46)，高LDH组选择30Gy10次/2周(C组，n=35)或20Gy5次/1周(D组，n=35)，B组尽可能缩小治疗野。
结果
2.急性副作用的发生率呈单次剂量依赖的趋势，A组(3Gy/次)、B组(2.5Gy/次)、21%(p=0.165)和C组(3Gy/次)、D组(4Gy/次)分别为23%和23%；中位生存期和1年生存率A组分别为5.4月和21%，B组分别为4.8月和17%，C组分别为3.4月和6%。4.神经功能改善随着总剂量的增加而增加，A组为41%，B组为45%，C组为35%，D组为21%(p=0.13)。
结论
短疗程(30Gy10次/2周)是一种有利的XRT，因为LDH正常组治疗时间短，高LDH组神经功能改善时间短，毒性小，但对于所选择的患者可能需要选择治疗。
PURPOSE
Since September 1980 we have been conducting a prospective randomized trial to determine the best treatment schedule for radiation therapy (XRT) on brain metastasis from lung carcinoma. The first trial (September 1980 to December 1984) was randomly allocated by two different time-dose radiotherapy schemes, i.e., 30 Gy/ten fractions/two weeks versus 50 Gy/20 fractions/four weeks. Treatment results showed no significant difference in neurological improvement and survival between the two arms and lactate dehydrogenase (LDH) as the most important prognostic factor. The present study (January 1985 to April 1992) examines two sequential trials stratified by the level of LDH enrolled 162 patients with brain metastasis from lung carcinoma.
PATIENTS AND METHODS
Whole brain dose was selected for 30 Gy/ten fractions/two weeks (group A, n = 46) or 50 Gy/20 fractions/four weeks (group B, n = 46) in the group with normal LDH and 30 Gy/ten fractions/two weeks (group C, n = 35) or 20 Gy/five fractions/one week (group D, n = 35) in the group with high LDH, while the treatment fields were shrunk at 30 Gy in group B if possible.
RESULTS
The final results showed the facts that 1. the most important prognostic factor, according to Cox's multivariate analysis, was also the level of LDH in the second trial, 2. the incidence of acute side effects showed the trend toward depending upon a single dose, i.e., group A (3 Gy/fraction); 35% versus group B (2.5 Gy/fraction); 21% (p = 0.165) and group C (3 Gy/fraction); 23% versus group D (4 Gy/fraction); 45% (p = 0.044), 3. median survival time and one-year survival rates were 5.4 months and 21% in group A; 4.8 months and 17% in group B; 3.4 months and 6% in group C; and 2.4 months and 4% in group D, respectively, and survival curves showed no statistically significant difference between the two treatment groups in each LDH group, 4. improvement in neurologic function appeared to increase with total dosage escalation, i.e., 41% in group A versus 45% in group B and 35% in group C versus 21% in group D (p = 0.13).
CONCLUSION
A short course (30 Gy/ten fractions/two weeks) is an advantageous XRT because of the short treatment time for normal LDH and neurological improvement and minor toxicity for the high LDH group, while an optional treatment may be necessary for the selected patients.