肺癌よりの転移性脳腫瘍の治療方法について:performance statusの推移よりの検討

Treatment of metastatic brain tumors from lung cancer:analysis of performance status between treatment methods

I．はじめに

　癌患者の治療についてはquality of life（Q．0．L．）が唱えられて久しく，performance status（PS）の程度が重要である．転移性脳腫瘍の場合は症状の軽減が主となり，残された限りある人生における個々のfunctional statusを維持することに主眼がおかれる．特に脳以外の癌病巣およびそれに対する治療等による抵抗力の低下等があらかじめ存在する場合が多く，積極的治療が即，好結果につながらない．悪性脳腫瘍患者では免疫能の低下が報告され^6,20）特に高年齢患者に対しては免疫力^4,18），回復力が悪いため治療中のPSが特に重要となる．現在転移性脳腫瘍は主に手術療法，放射線療法，化学療法から成り，その適応，治療法については多くの議論がなされている^3,15）．今回PSとしてKamofsky score（KS）の変化を追求しそれよりこれらの転移性脳腫瘍の治療法についてPSの観点から検討した．

Retrospective analysis was peformed in 280 patients;112 surgical cases and 168 non-surgical cases to deter-mine which of three treatments, alone or in combina-tion provides more prolonged improvement of perform-ance status (PS:Karnofsky score) in patients with metastatic brain tumors from lung cancer. The treat-ments under scrutiny were surgical removal of metasta-tic brain tumor (5), radiation therapy (R) and che-motherapy (C). KS in the group treated with S or C showed a significantly better result than that in the non-S group or non-C group during the two-year observation period. However, R group showed no signi-ficant improvement in KS compared to that in the non-C group during the two-year period. During the first year after admission, two subgroups of S plus R and R alone showed most rapid decrease in KS. However, subgroups of S plus C and S plus R and C showed bet-ter results than other subgroups. In analyzing the changes in KS over the short period from admission to one month after treatment had been completed, the non-S group showed a significant decrease in KS, while the S group showed a slight increase in mean KS. The subgroup of R alone showed the greatest decrease in KS. Thus, retrospective analysis showed that surgical removal of a metastatic brain tumor led to improved KS for a short period and chemotheapy was useful in prolonging the duration of better Q.O.L.