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1、肺癌脑转移的治疗进展江浩肿瘤放疗中心蚌埠医学院第一附属医院蚌埠医学院附属肿瘤医院一石激起千重浪？MulvennaP,etal.Lancet.2016Oct22;388(10055):2004-2014.WBRTforNSCLC：Yes&No？MulvennaP,etal.Lancet.2016Oct22;388(10055):2004-2014.本研究的一般描述anon-inferiority,phase3randomisedtrialdoneat69UKandthreeAustraliancentres.
2、NSCLCpatientswithbrainmetastasesunsuitableforsurgicalresectionorstereotacticradiotherapyoptimalsupportivecare(OSC)includingdexamethasoneplusWBRT(20Gyinfivedailyfractions)orOSCaloneincludingdexamethasoneTheprimaryoutcomemeasure：quality-adjustedlife-years(QA
3、LYs).QALYsweregeneratedfromoverallsurvivalandpatients’weeklycompletionoftheEQ-5Dquestionnaire.BetweenMarch2,2007,andAug29,2014,538patientswererecruitedfrom69UKandthreeAustraliancentres,andwererandomlyassignedtoreceiveeitherOSCplusWBRT(269)orOSCalone(269).I
4、nterpretationAlthoughtheprimaryoutcomemeasureresultincludestheprespecifiednon-inferioritymargin,thecombinationofthesmalldifferenceinQALYsandtheabsenceofadifferenceinsurvivalandqualityoflifebetweenthetwogroupssuggeststhatWBRTprovideslittleadditionalclinical
5、lysignificantbenefitforthispatientgroup.OverallSurvivalAverageQualityofLifeAverageQALYForestPlotofSurvivalInsummaryQUARTZprovidescompellinginformationforcliniciansandpatientsalike;foryoungerpatients,WBRTmightofferasurvivaladvantagebutforallothergroups,omit
6、tingWBRTdoesnotsignificantlyaffectQALYoroverallsurvival.Nov.2016：WBRTforNSCLCtheendofanera?AnnaM.E.B,etal.JThorac.Dis.2016;8(11):E1525-E1527RTOG-RPA:Class1-3Athree-classrecursivepartitioning(RPA)systembytheRTOGtodescribedifferentprognosticgroupsofpatientsw
7、ithbrainmetastases.RPAClassI:themostfavorableprognosticgroup,KPS≥70,anage≤65yearsandcontrolledprimarytumorwithoutextracranialmetastases.RPAClassIII:thepoorestprognosispatients,KPS<70.RPAClassII:TheremaindersofpatientsGasparLE,etal.IntJRadiatOncolBiolPhys.2
8、000;47:1001-6.Howtochoose？QuartztrialisgroundbreakinginthatitisthefirstprospectiverandomizedstudyprovidingevidencethatpoorprognosispatientswithbrainmetastasesfromNSCLCdonotbenefitfromWBRT,andBSCshouldberegard
