SRS+贝伐珠单抗±WBRT治疗EGFR野生型或耐药肺腺癌脑转移瘤疗效比较  

Comparing with treatment outcome of brain metastases from lung adenocarcinoma with EGFR wild-type or drug resistance for stereotactic radiotherapy combined with bevacizumab±brain radiotherapy

作　　者：李璐[1] 吴奕霖 徐鹏[1] 阴骏[1] 黄叶才[1] 谭明宇 郞锦义 冯梅 Li Lu;Wu Yilin;Xu Peng;Yin Jun;Huang Yecai;Tan Mingyu;Lang Jinyi;Feng Mei(Department of Radiation Oncology,Sichuan Cancer Hospital,Chengdu 610041,China;Department of Oncology,The People's Hospital of Yuechi County,Sichuan Province,Guangan 638373,China;Department of Medical Oncology,Third People’s Hospital of Sichuan,Chengdu 610072,China)

机构地区：[1]四川省肿瘤医院放疗科,成都610041 [2]四川省岳池县人民医院肿瘤科,广安638373 [3]四川省第三人民医院肿瘤内科,成都610072

出　　处：《中华转移性肿瘤杂志》2022年第3期235-240,共6页Chinese Journal of Metastatic Cancer

基　　金：四川省科技计划项目(2022YFS0047);电子科技大学、四川省肿瘤医院肿瘤医学与工程创新基金(No.ZYGX2021YGCX006)

摘　　要：目的比较立体定向放射外科(SRS)+贝伐珠单抗±全脑放疗(WBRT)对EGFR野生型或耐药肺腺癌脑转移瘤的治疗结果。方法回顾分析2012—2019年间四川省肿瘤医院采用SRS+贝伐珠单抗±WBRT对EGFR野生型或耐药肺腺癌脑转移瘤患者32例资料,其中SRS+贝伐珠单抗+WBRT患者19例,SRS+贝伐珠单抗13例。比较两组治疗结果、瘤周水肿体积、神经认知功能变化和不良反应。结果中位随访时间13.5个月(2.7~88.4个月)。两组客观缓解率(P=0.687)、中位生存时间(P=0.920)和无进展生存时间(P=0.513)均相似。SRS+贝伐珠单抗+WBRT比SRS+贝伐珠单抗患者瘤周水肿体积仍较大((20.00±11.33)cm^(3)∶(8.23±6.13)cm^(3),P=0.043),且简易精神状态评价量表评分也明显降低(25.95±1.47∶27.14±1.41,P=0.023)。不良反应主要为头痛、静脉血栓事件、高血压、蛋白尿和瘤体内出血,两组发生率相似。结论SRS+贝伐珠单抗±WBRT对EGFR野生型或耐药肺腺癌脑转移瘤的疗效相似,但辅助性WBRT增加瘤周水肿的控制难度并影响神经认知功能。Objective To compare with treatment outcome of brain metastases from lung adenocarcinoma with EGFR wildtype or drug resistance for stereotactic radiotherapy(SRS)+bevacizumab±brain radiotherapy(WBRT).Methods From 2012 to 2019,retrospective analysis of 32 patients with brain metastases from lung adenocarcinoma with EGFR wildtype or drug resistance for SRS+bevacizumab±WBRT.Among them,19 patients were treated with SRS+bevacizumab+WBRT,and 13 patients were treated with SRS+bevacizumab.To compare with treatment outcome,peritumoral edema volume,neuro-cognitiveand and toxicity in tow groups.Results The median follow-up time was 13.5months(range 2.7-88.4 months).The objective response rates(P=0.687),median survival time(P=0.920),and progression-free survival time(P=0.513)were similar in tow groups.However,the volume of peritumoral edema after treatment in the WBRT+SRS group was still large((20.00±11.33)cm^(3)vs.(8.23±6.13)cm^(3),P=0.043),and the MMSE score was significantly lower than that in the SRS group(25.95±1.47 vs.27.14±1.41,P=0.023).The main adverse reactions were headache,thrombus events,hypertension,albuminuria and intratumoral hemorrhage,and similar in two groups.Conclusions SRS+bevacizumab±WBRT has similar effects,but adjuvant WBRT increases the difficulty of controlling peritumoral edema and reduces neurocognitive function.

关 键 词：脑转移 肺腺癌 EGFR野生型 肺腺癌 耐药 肺腺癌 立体定向放疗 贝伐珠单抗治疗 全脑放疗 治疗结果 

分 类 号：R73[医药卫生—肿瘤]