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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2026, Vol. 19 ›› Issue (01) : 76 -82. doi: 10.3877/cma.j.issn.1674-6902.2026.01.012

论著

不同分割模式同步推量调强放疗92例肺癌脑转移的临床研究
马池銮1, 贾殿军1, 魏冬冬1, 石亮2, 张晓微3, 赵悦1,†()   
  1. 1061000　沧州，沧州市中心医院胸部肿瘤放疗科
    2061000　沧州，沧州市中心医院普外窥镜室
    3061000　沧州，沧州师范学院生命科学系
  • 收稿日期:2025-07-22 出版日期:2026-02-25
  • 通信作者: 赵悦
  • 基金资助:
    2021年沧州市科技计划自筹经费项目(213106050)

Clinical study on simultaneous integrated boost intensity-modulated radiotherapy with different segmentation modes in the treatment of 92 cases of brain metastases from lung cancer

Chiluan Ma1, Dianjun Jia1, Dongdong Wei1, Liang Shi2, Xiaowei Zhang3, Yue Zhao1,†()   

  1. 1Department of Thoracic Radiation Oncology, Cangzhou Central Hospital, Cangzhou 061000, China
    2General Surgery Endoscopy Unit, Cangzhou Central Hospital, Cangzhou 061000, China
    3Department of Life Sciences, Cangzhou normal university, Cangzhou 061000, China
  • Received:2025-07-22 Published:2026-02-25
  • Corresponding author: Yue Zhao
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引用本文：

马池銮, 贾殿军, 魏冬冬, 石亮, 张晓微, 赵悦. 不同分割模式同步推量调强放疗92例肺癌脑转移的临床研究[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(01): 76-82.

Chiluan Ma, Dianjun Jia, Dongdong Wei, Liang Shi, Xiaowei Zhang, Yue Zhao. Clinical study on simultaneous integrated boost intensity-modulated radiotherapy with different segmentation modes in the treatment of 92 cases of brain metastases from lung cancer[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(01): 76-82.

目的

探讨不同分割模式同步推量调强放疗(simultaneous integrated boost intensity modulated radiation therapy, SIB-IMRT)对肺癌脑转移(brain metastases, BM)患者颅内进展、认知功能、免疫功能和生活质量的影响。

方法

前瞻性选择2021年11月至2024年12月沧州市中心医院收治的92例肺癌多发性BM患者为对象，随机分为A组49例、B组43例，A组行全脑40Gy/20Fx＋局部加量60Gy/20Fx放疗，B组行全脑37.5Gy/15Fx＋局部加量52.5Gy/15Fx放疗。记录颅内无进展生存时间(intracranial progression free survival, iPFS)。采用流式细胞术检测放疗前后血液淋巴细胞亚群。绘制Kaplan-Meier曲线分析不同分割模式对iPFS的影响。使用重复测量方差分析不同分割模式对认知功能、生活质量及细胞免疫功能(CD3＋、CD4＋、CD8＋%)的影响。

结果

中位随访9.93个月，生存者71例(77.17%)，死亡者21例(22.83%)。发生颅内进展/复发59例(64.13%)，A组iPFS 4.90个月(95%CI：3.42~6.38个月)少于B组iPFS时间12.60个月(95%CI：10.28~14.92个月)(Log-Rank＝12.621，P＝0.000)。发生治疗相关不良事件44例，两组不良事件发生率差异无统计学意义(P>0.05)。B组蒙特利尔认知评分放疗后4个月(23.13±1.45)分、6个月(23.09±2.00)分高于A组4个月(20.97±2.35)分、6个月(18.35±2.41)分(P＝0.000)；B组放疗后6个月日常生活活动Barthel指数(8.74±2.47)高于A组(6.95±0.39)(P＝0.001)。放疗后2个月B组CD8＋%32.50(23.90，41.10)水平高于A组27.10(17.65，36.03)(P＝0.001)。重复方差分析显示CD8＋%(F组别×时间＝6.966，P＝0.012)存在组间交互作用。

结论

全脑37.5Gy/15Fx＋局部加量52.5Gy/15Fx方案延长肺癌多发性BM患者iPFS，有助于维持放疗后免疫功能、认知能力及生活质量。

关键词: 支气管肺癌, 肺癌脑转移, 同步推量调强放疗, 分割剂量, 颅内进展, 认知功能, 生活质量, 免疫功能
Objective

To explore the effects of synchronous intensity-modulated radiotherapy (SIB-IMRT) with different segmentation modes on intracranial progression, cognitive function, immune function, and quality of life in patients with lung cancer brain metastases (BM).

Methods

A prospective study was conducted on 92 patients with brain metastases (BM) admitted to Cangzhou Central Hospital from November 2021 to December 2024. They were randomly divided into Group A 49 cases (40Gy/20Fx whole brain+ local addition of 60Gy/20Fx) and Group B 43 cases (37.5Gy/15Fx whole brain+ local addition of 52.5Gy/15Fx). The intracranial progression free survival time (iPFS) was recorded. The flow cytometry was performed to detect blood lymphocyte subsets before and after radiotherapy. Kaplan-Meier curves was used to analyze the impact of different segmentation modes on iPFS. The effects of different segmentation modes on cognitive function, quality of life, and cellular immune function (CD3+, CD4+, CD8+ %) were analyzed by repeated measures method of variance.

Results

During a median follow-up of 9.93 months, there were 21 deaths and 71 survivors. In addition, 59 patients (64.13%) experienced intracranial progression/recurrence, while the duration of iPFS 4.90 months (95%CI: 3.42-6.38 months) in Group A was less than the duration of iPFS 12.60 months (95%CI: 10.28~14.92 months) in Group B, Log-Rank=12.621, P=0.000. 44 treatment-related adverse events occurred, and there was no statistically significant difference in the incidence of adverse events between the two groups (P>0.05). At 4 and 6 months after radiotherapy, the Montreal cognitive scores of Group B (23.13±1.45) and (23.09±2.00) were higher than that of Group A (20.97±2.35) and (18.35±2.41), P=0.000; the Barthel index of daily living activities in group B (8.74±2.47) was higher than that in group A (6.95±0.39) at 6 months after radiotherapy (P=0.001). After radiotherapy for 2 months, CD8+ % 32.50(23.90, 41.10) in group B was higher than that in group A 27.10(17.65, 36.03)(P=0.001). Repeated analysis of variance showed that CD8+ % (Fgroup×time=6.966, P=0.012) had inter group interactions.

Conclusions

The whole brain 37.5Gy/15Fx+ local dose 52.5Gy/15Fx regimen can prolong iPFS in patients with multiple BM of lung cancer and help to maintain their immune function, cognitive ability, and quality of life after radiotherapy.

Key words: Bronchogenic carcinoma, Bronchogenic carcinoma with brain metastases, Simultaneous integrated boost intensity-modulated radiotherapy, Segmentation dose, Intracranial progression, Cognitive function, Quality of life, Immune function
表1 两组肺癌多发性BM患者临床资料结果
临床资料 A组(n＝49) B组(n＝43) t/Z/χ2值 P值
实验室指标[M50(P25，P75)]        
癌胚抗原(ng/ml) 8.59(3.11，34.80) 11.81(2.86，41.58) 0.250 0.803
神经元特异性烯醇化酶(ng/ml) 15.83(12.00，21.07) 14.58(11.32，23.00) 0.472 0.637
细胞角蛋白21-1(ng/ml) 5.65(3.45，17.25) 5.05(3.28，14.45) 0.441 0.659
病理亚型[n(%)]     1.266 0.261
肺腺癌 43(87.76) 34(79.07)    
肺鳞癌及其它 6(12.24) 9(20.93)    
T分期[n(%)]     0.393 0.531
1~2 26(53.06) 20(46.51)    
3~4 23(46.94) 23(53.49)    
N分期[n(%)]     0.210 0.647
0~2 33(67.35) 27(62.79)    
3 16(32.65) 16(37.21)    
表皮生长因子受体突变[n(%)] 23(46.94) 25(58.14) 1.151 0.283
脑部放疗参数[M50(P25，P75)]        
肿瘤转移数量(个) 1.00(1.00，4.00) 2.00(1.00，5.00) 1.137 0.256
确诊至脑放疗间隔(d) 6.00(2.75，56.25) 7.00(1.75，23.50) 0.520 0.603
总肿瘤靶区(cc) 2.12(1.22，2.58) 1.81(0.82，4.29) 0.875 0.381
治疗史[n(%)]        
肺部手术 19(38.78) 11(25.58) 1.814 0.178
肺部放疗 15(30.61) 13(30.23) 0.002 0.969
转移灶手术 3(6.12) 1(2.33)   0.620
化疗 35(71.43) 27(62.79) 0.778 0.378
酪氨酸激酶抑制剂 9(18.37) 5(11.63) 0.806 0.369
图1 肺癌多发性BM患者MRI影像图。图A为放疗前颅内多发性脑转移；图B为放疗后异质性增强病变，部分病灶较前缩小
图2 两组肺癌多发性BM患者认知功能和生活质量变化注：MoCA为蒙特利尔认知评估；FACT-BR为癌症治疗功能评估-脑分量表；Barthel-ADLs为日常生活活动Barthel指数；与A组相比，*P<0.05，***P<0.001
表2 两组肺癌多发性BM患者细胞免疫功能变化比较
淋巴细胞 A组(n＝49) B组(n＝43) Z值 P值
例数[n(%)] [M50(P25，P75)] 例数[n(%)] [M50(P25，P75)]
CD3＋%            
基线 49(100.00) 71.97(58.78，80.03) 43(100.00) 67.18(53.12，77.70) 1.390 0.165
放疗2个月 43(87.76) 56.65(47.88，63.95) 42(97.67) 52.90(44.80，61.10) 1.538 0.124
变化值 43(87.76) 10.35(20.31，2.91) 42(97.67) 12.88(28.18，3.30) 0.743 0.458
CD4＋%            
基线 49(100.00) 60.20(49.58，67.88) 43(100.00) 60.80(46.05，65.35) 0.566 0.571
放疗2个月 43(87.76) 36.40(23.90，45.23) 42(97.67) 42.00(24.60，50.00) 1.292 0.196
变化值 43(87.76) 26.20(37.88，15.40) 42(97.67) 19.80(29.30，6.00) 1.951 0.051
CD8＋%            
基线 49(100.00) 34.00(28.28，42.82) 43(100.00) 33.55(25.70，55.23) 0.375 0.708
放疗2个月 43(87.76) 27.10(17.65，36.03) 42(97.67) 32.50(23.90，41.10) 3.248 0.001
变化值 43(87.76) 5.80(17.18，0.38) 42(97.67) 1.30(9.20，1.60) 2.000 0.046
CD4＋/CD8＋            
基线 49(100.00) 1.58(1.32，2.20) 43(100.00) 1.61(1.13，2.26) 0.441 0.659
放疗2个月 43(87.76) 1.11(0.68，1.75) 42(97.67) 0.99(0.56，1.28) 1.406 0.160
变化值 43(87.76) 0.64(1.14，0.13) 42(97.67) 0.59(1.35，0.11) 0.650 0.515
表3 两组肺癌多发性BM患者放疗安全性结果[n(%)]
不良事件 A组(n＝49) B组(n＝43) χ2值 P值
内耳和迷路功能障碍(1~2级) 3(6.12) 1(2.33)   0.620
眼部功能障碍(1~2级) 0(0.00) 1(2.33)   0.467
消化道毒性反应(1~2级) 5(10.20) 2(4.65) 1.005 0.316
疲劳 12(24.49) 4(9.30) 3.677 0.055
1~2级 11(22.45) 4(9.30) 2.901 0.089
3级 1(2.17) 0(0.00)   0.476
头痛 10(20.41) 3(6.98) 3.405 0.065
1~2级 9(18.37) 3(6.98) 2.620 0.106
3级 1(2.04) 0(0.00)   0.476
放射性皮炎(1~2级) 1(2.04) 1(2.33)    
代谢和营养紊乱(1~2级) 1(2.04) 1(2.33)    
认知功能障碍 13(26.53) 7(16.28) 1.415 0.234
1~2级 11(22.45) 7(16.28) 0.554 0.457
3级 2(4.08) 0(0.00)   0.497
皮肤和皮下组织毒性反应(1~2级) 12(24.49) 6(13.95) 1.616 0.204
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