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

doi:10.3877/cma.j.issn.1674-6902.2026.01.012

Abstract

Abstract:

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

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]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(01): 76-82.

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References 29

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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

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

淋巴细胞	A组(n＝49)		B组(n＝43)		Z值	P值
淋巴细胞	例数[n(%)]	[M₅₀(P₂₅，P₇₅)]	例数[n(%)]	[M₅₀(P₂₅，P₇₅)]	Z值	P值
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

淋巴细胞	A组(n＝49)		B组(n＝43)		Z值	P值
淋巴细胞	例数[n(%)]	[M₅₀(P₂₅，P₇₅)]	例数[n(%)]	[M₅₀(P₂₅，P₇₅)]	Z值	P值
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

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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