不同分割模式立体定向放射治疗对肺癌脑转移瘤局部控制率、神经认知功能及生存预后的影响

doi:10.19854/j.cnki.1008-2425.2026.02.0005

摘要/Abstract

摘要： 目的比较单次立体定向放射外科(SRS)与分次立体定向放射治疗(FSRT)对肺癌脑转移瘤患者局部控制率(LC)、神经认知功能及生存预后的影响。方法将2018年1月至2024年12月收治的216例肺癌脑转移患者(转移灶1~4个,直径≤3 cm,KPS≥70)。根据治疗方式分为SRS组(n=108,单次剂量18~24 Gy)和FSRT组(n=108,分割方案:27~35 Gy/3-5F)。主要研究终点为1年局部控制率(LC)和神经认知功能变化(采用MMSE和MoCA量表评估基线及治疗后6、12个月评分);次要终点包括总生存期(OS)、颅内无进展生存期(iPFS)及放射性坏死(RN)等不良反应。采用Kaplan-Meier法计算生存率并比较认知评分变化。结果中位随访15.2个月,两组局部控制率(LC)比较显示,FSRT组1年LC率为88.33%,高于SRS组的74.07%,差异有统计学意义(P=0.009);SRS组各时间点MMSE及MoCA评分较基线波动小,FSRT组在治疗后6、12个月两项评分均显著低于SRS组(均P＜0.05),且随时间推移差异扩大;生存预后比较,两组中位OS及中位iPFS差异无统计学意义(P=0.172、0.231);FSRT组症状性RN发生率显著低于SRS组(P=0.002)。结论对于肺癌脑转移瘤,FSRT相比SRS可提供更高的1年局部控制率,并显著降低症状性放射性坏死风险。然而,SRS在长期神经认知功能保护方面更具优势,主要体现在MMSE及MoCA评分的稳定性上。治疗选择应权衡肿瘤控制与神经功能保护。

关键词: 肺癌脑转移瘤, 立体定向放射外科, 分次立体定向放射治疗, 局部控制率, 神经认知功能, 生存预后

Abstract: Objective Compare the effects of single-fraction stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy(FSRT) on local control rate(LC),neurocognitive function,and survival prognosis in patients with brain metastases from lung cancer. Methods A total of 216 patients with brain metastases from lung cancer (1-4 metastatic lesions,diameter≤3 cm,KPS≥70) admitted from January 2018 to December 2024 were enrolled.They were divided into the SRS group(n=108,single dose of 18-24Gy) and the FSRT group (n=108,fractionation scheme:27-35 Gy/3-5 F) according to the treatment method.The primary study endpoints were the 1-year local control rate(LC) and changes in neurocognitive function (assessed by MMSE and MoCA scales at baseline and 6 and 12 months after treatment);the secondary endpoints included overall survival (OS),intracranial progression-free survival (iPFS),and adverse events such as radiation necrosis(RN).The Kaplan-Meier method was used to calculate the survival rate and compare the changes in cognitive scores. Results With a median follow-up of 15.2 months,comparison of local control rate(LC) between the two groups showed that the 1-year LC rate in the FSRT group was 88.33%,which was higher than 74.07% in the SRS group,with a statistically significant difference (P=0.009).The MMSE and MoCA scores in the SRS group fluctuated slightly compared with the baseline at all time points,while the two scores in the FSRT group at 6 and 12 months after treatment were significantly lower than those in the SRS group (both P＜0.05),and the difference widened over time.In terms of survival prognosis,there were no statistically significant differences in median overall survival (OS) and median intracranial progression-free survival (iPFS) between the two groups (P=0.172,0.231).The incidence of symptomatic radiation necrosis (RN) in the FSRT group was significantly lower than that in the SRS group (P=0.002). Conclusion For brain metastases from lung cancer,compared with SRS,FSRT can provide a higher 1-year local control rate and significantly reduce the risk of symptomatic radiation necrosis.However,SRS has more advantages in long-term neurocognitive function protection,which is mainly reflected in the stability of MMSE and MoCA scores.Treatment selection should balance tumor control and neurological function preservation.

Key words: Brain metastases from lung cancer, Stereotactic Radiosurgery(SRS), Fractionated stereotactic radiotherapy(FSRT), Local control rate(LC), Neurocognitive function, Survival prognosis

中图分类号:

R815

王雅迪, 张国荣, 彭粉花. 不同分割模式立体定向放射治疗对肺癌脑转移瘤局部控制率、神经认知功能及生存预后的影响[J]. 立体定向和功能性神经外科杂志, 2026, 39(2): 92-99.

Wang Yadi, Zhang Guorong, Peng Fenhua. The impact of different fractionated stereotactic radiotherapy modes on local control rate,neurocognitive function,and survival prognosis of brain metastases from lung cancer[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2026, 39(2): 92-99.

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