Abstract: Objective To investigate the clinical efficacy and prognostic factors of stereotactic radiotherapy for brain metastasis of colorectal cancer.Methods The general clinical features,clinical efficacy and prognostic factors of 39 patients with brain metastasis from colorectal cancer treated with stereotactic radiotherapy with or without chemotherapy were reviewed retrospectively.Results The primary site were mainly in the rectum and left colon and .There were 36 patients with extracranial metastasis.The cumulative rates of brain metastases were 10.3%(4/39),51.3%(20/39) and 84.6%(33/39) at 1,3 and 5 years.All patients had postoperative rectal cancer,which occurred after lung or livermetastasis.The local control rate of short-term efficacy evaluation was 94% at 6 months and 89% at 12 months,and the median survival was 10.6 months.Adverse reactions,including transient cerebral edema and radiation brain injury,were alleviated with symptomatic treatment and bevacizumab.Multivariate analysis showed that the independent risk factors for prognosis of patients with colorectal cancer BMS were the number of BMS and treatment mode(all P<0.05).Conclusion Brain metastases of colorectal cancer occur mostly after lung and liver metastases with poor prognosis.Stereotactic radiotherapy combined with chemotherapy and targeted therapy(bevacizumab) prolongs patient survival.Survival analysis showed that the number of BMS and treatment pattern were independent risk factors affecting patients with brain metastasis of colorectal cancer.

Key words: Rectal cancer, Brain metastasis, Stereotactic radiotherapy

摘要： 目的 探讨结直肠癌脑转移接受立体定向放射治疗的临床疗效和预后因素分析。方法 回顾性总结了采用立体定向放疗治疗联合或不联合化疗的39例结直肠癌脑转移患者的临床特征,临床疗效,以及影响生存的预后因素。结果 患者原发灶多发生于左半结肠,以直肠为主。合并颅外转移患者36例。本组病例1年、3年、5年的累积脑转移率为10.3%(4/39)、51.3%(20/39)、84.6%(33/39)。结直肠癌脑转移多发生于肺转移或肝转移后(36/39)。患者近期疗效评价局部控制率6个月为94%,12个月为89%,中位生存期为10.6个月。不良反应包括一过性脑水肿以及放射性脑损伤,给予对症治疗及贝伐珠单抗治疗后可缓解。多因素分析显示,结直肠癌脑转移患者预后的独立风险因素为脑转移瘤数目和治疗模式(均P<0.05)。结论 结直肠癌脑转移多发生于肺、肝转移之后,预后不良;立体定向放疗联合化疗和靶向治疗(贝伐珠单抗)能够延长患者生存期。生存分析表明:影响结直肠癌脑转移患者的独立风险因素为脑转移瘤数目和治疗模式。

关键词: 直肠癌, 脑转移, 立体定向放射治疗