脑转移瘤手术联合立体定向放射治疗与单纯SRS的疗效对比

Comparison of Efficacy of Surgery Combined with Stereotactic Radiosurgery versus Stereotactic Radiosurgery Alone for Brain Metastases

摘要: 目的：对比脑转移瘤采用手术联合立体定向放射治疗(SRS)与单纯立体定向放射治疗(SRS)的临床疗效及安全性，为临床治疗方案的选择提供循证依据。方法：回顾性分析2022年1月至2025年12月在本院治疗的脑转移瘤患者86例为研究对象按照治疗方案的不同分为联合组(43例)和单纯组(43例)。联合组采用手术切除联合术后SRS治疗，单纯组采用单纯SRS治疗。比较两组患者的治疗有效率、肿瘤局部控制率、无进展生存期(PFS)、总生存期(OS)，以及治疗期间不良反应发生率和治疗后神经功能缺损评分(NIHSS)变化。结果：组间对比可见，联合组86.05%的治疗有效率高于单纯组65.12%，差异存在统计学意(P < 0.05)。联合组治疗后6个月、12个月的肿瘤局部控制率(93.02%、83.72%)均显著高于单纯组(76.74%、62.79%)，差异有统计学意义(P < 0.05)。联合组中位无进展生存期(10.5个月)、中位总生存期(18.2个月)均显著长于单纯组(6.8个月、12.3个月)，差异有统计学意义(P < 0.05)。两组患者治疗期间不良反应(放射性脑水肿、头痛、恶心呕吐、神经功能损伤)发生率比较，差异无统计学意义(P > 0.05)；相较于单纯组，联合组在治疗后3个月、6个月的NIHSS评分均显著降低，差异有统计学意义(P < 0.05)。结论：脑转移瘤采用手术联合SRS治疗的疗效优于单纯SRS治疗，可显著提高治疗有效率和肿瘤局部控制率，延长患者生存期，同时不会增加不良反应发生率，还能更好地改善患者神经功能，值得临床推广应用。

Abstract: Objective: To compare the clinical efficacy and safety of surgery combined with stereotactic radiosurgery (SRS) versus SRS alone in the treatment of brain metastases, and to provide evidence-based basis for the selection of clinical treatment regimens. Methods: A retrospective analysis was conducted on 86 patients with brain metastases treated in our hospital from January 2022 to December 2025, who were divided into the combination group (43 cases) and the SRS alone group (43 cases) according to different treatment regimens. The combination group was treated with surgical resection combined with postoperative SRS, and the SRS alone group was treated with SRS only. The treatment response rate, local tumor control rate, progression-free survival (PFS), overall survival (OS), incidence of adverse reactions during treatment, and changes in National Institutes of Health Stroke Scale (NIHSS) score after treatment were compared between the two groups. Results: The treatment response rate of the combination group was 86.05%, which was higher than 65.12% of the SRS alone group, with a statistically significant difference (P < 0.05). The local tumor control rates of the combination group at 6 months and 12 months after treatment (93.02%, 83.72%) were significantly higher than those of the SRS alone group (76.74%, 62.79%), with statistically significant differences (P < 0.05). The median progression-free survival (10.5 months) and median overall survival (18.2 months) of the combination group were significantly longer than those of the SRS alone group (6.8 months, 12.3 months), with statistically significant differences (P < 0.05). There was no significant difference in the incidence of adverse reactions (radiogenic brain edema, headache, nausea and vomiting, neurological function injury) between the two groups during treatment (P > 0.05). Compared with the SRS alone group, the NIHSS scores of the combination group at 3 months and 6 months after treatment were significantly decreased, with statistically significant differences (P < 0.05). Conclusion: Surgery combined with SRS has better efficacy than SRS alone in the treatment of brain metastases, which can significantly improve the treatment response rate and local tumor control rate, prolong the survival time of patients, without increasing the incidence of adverse reactions, and can better improve the neurological function of patients, which is worthy of clinical promotion and application.