發(fā)布時(shí)間：2018-05-17 02:41

  本文選題：非小細(xì)胞肺癌 + 腦轉(zhuǎn)移瘤��； 參考：《廣東醫(yī)學(xué)》2017年10期

【摘要】：目的評(píng)價(jià)替莫唑胺聯(lián)合全腦放療治療非小細(xì)胞肺癌腦轉(zhuǎn)移瘤患者的療效和安全性。方法將31例非小細(xì)胞肺癌腦轉(zhuǎn)移瘤患者納入研究,全部患者均有原發(fā)灶病理診斷,腺癌23例、鱗癌7例、腺鱗癌1例;并經(jīng)頭顱增強(qiáng)MRI顯示顱內(nèi)轉(zhuǎn)移灶≥3個(gè),原發(fā)病灶已控制(包括原發(fā)病灶已切除或原發(fā)病灶雖未切除但得到藥物治療達(dá)部分緩解(PR)/完全緩解(CR)≥2個(gè)月),且無(wú)顱外轉(zhuǎn)移病灶存在或顱外轉(zhuǎn)移病灶得到控制≥2個(gè)月。全腦放療DT 30 Gy,3 Gy/次,5次/周;所有患者于放療第1天開(kāi)始給予替莫唑胺口服治療[75 mg/(m2·d)],直至放療結(jié)束,放療結(jié)束后4周繼續(xù)予以6周期替莫唑胺輔助化療,方案為150~200 mg/(m2·d),連續(xù)服用5 d,28 d為1個(gè)周期。觀察患者療效及安全性,并對(duì)患者性別、年齡、轉(zhuǎn)移瘤個(gè)數(shù)、病理類(lèi)型、有無(wú)表皮生長(zhǎng)因子受體(EGFR)突變、有無(wú)伴有顱外轉(zhuǎn)移病灶、RPA分級(jí)、近期療效有無(wú)達(dá)CR以及放療前有無(wú)認(rèn)知功能損傷等因素對(duì)患者預(yù)后的影響進(jìn)行多因素分析。結(jié)果放療結(jié)束后4周復(fù)查頭顱增強(qiáng)MRI,全組患者客觀緩解率(ORR)為74.1%(23/31),其中CR率為19.3%(6/31),PR率為54.8%(17/31)。隨訪截止于2016年8月1日,23例患者死亡,中位無(wú)顱內(nèi)進(jìn)展時(shí)間11.5個(gè)月,中位生存時(shí)間13個(gè)月,1年無(wú)進(jìn)展生存(PFS)、總生存(OS)分別為63.1%、64.5%。常見(jiàn)毒性不良反應(yīng)為惡心、嘔吐,并伴有中性粒細(xì)胞及血小板的減少,但經(jīng)對(duì)癥處理后大部分患者均可緩解并耐受。多因素分析顯示RPA分級(jí)是影響OS的獨(dú)立預(yù)后因素;放療前認(rèn)知功能是否受損是影響PFS的獨(dú)立預(yù)后因素。結(jié)論替莫唑胺聯(lián)合全腦放療治療非小細(xì)胞肺癌腦轉(zhuǎn)移瘤具有較好的近期療效和安全性。
[Abstract]:Objective to evaluate the efficacy and safety of temozolidomide combined with whole brain radiotherapy in the treatment of brain metastases from non-small cell lung cancer (NSCLC). Methods Thirty-one patients with brain metastases from non-small cell lung cancer were included in the study. All the patients had primary lesions, including 23 adenocarcinoma, 7 squamous cell carcinoma and 1 adenosquamous carcinoma, and cranial enhanced MRI showed more than 3 intracranial metastases. The primary focus was controlled (including the primary lesion was resected or the primary lesion was not resected, but the drug treatment reached partial remission / complete remission CRS) 鈮，

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