非小细胞肺癌脑转移瘤治疗方案的优化选择  

Selection of optimal treatment scheme for brain metastases of non-small cell lung cancer

作　　者：董明新[1] 赵彤[1] 黄京子[1] 余淑坤[1] 冯燕[1] 田中成[1] 金香顺[1] 全吉钟[1] 刘金[1] 王冬旭[1] 

机构地区：[1]北华大学第二临床医院(吉化集团总医院)肿瘤治疗中心,吉林132022

出　　处：《中华放射医学与防护杂志》2006年第4期371-373,共3页Chinese Journal of Radiological Medicine and Protection

摘　　要：目的 优化选择非小细胞肺癌脑转移瘤的治疗方案。方法 72例均有病理学诊断的住院患者。随机分成3组。全颅外放疗组24例（Ⅰ组）。伽玛刀加全颅放疗组22例（Ⅱ组）。伽玛刀加全颅放疗联合Vm-26治疗组26例（Ⅲ组）。全脑外放疗中心剂量36～41 Gy,常规分割4～5周完成。伽玛刀治疗以50%等中心剂量曲线严格覆盖肿瘤边缘,处方剂量16～25 Gy,平均16 Gy。化疗：于全颅放疗DT19-29 Gy,2～3周后,加Vm-26化疗,60 mg·m^2·d^-1,连用3 d,21 d为1周期,共用2个周期。化疗期间继续放疗。结果 Ⅰ、Ⅱ和Ⅲ组的中位生存时间分别为6.0（1.2～19.0）、9.2（4.4～30.0）和10.8（5.2～42.2）个月,1、2年生存率分别为34.6%和12.6%;62.2%和30.2%;70.8%和35.6%。结论 采用3种不同方法治疗非小细胞肺癌脑转移瘤,Ⅲ组在提高局部控制率、延长生存期上明显优于Ⅰ组和Ⅱ组,且毒副作用可耐受。Objective To select the optimal treatment scheme for brain metastases of non-small cell lung cancers （NSCLCs） . Methods Seventy-two NSCLC cases diagnosesd by pathology with brain metastases were randomly classified into three groups, Group Ⅰ , 24 cases with whole brain conventional external fractioned irradiation of DT 36-41 Gy/4-5 w, Group Ⅱ , 22 cases with 7-knife treatment plus whole brain conventional external fractioned irradiation, and Group m, 26 cases with γ-knife plus whole brain conventional external fractioned irradiation in combination with chemotherapy of Vm-26. The surrounding area of tumor was strictly covered with 50% para-central-dosal curve in 7-knife treatment （DT 16-25 Gy with a mean of 16 Gy）. The mullleaf collimator was selected according to the volume of tumors. Chemotherapy of Vm-26 （60 mg/m^2 dl-3） was applied during the treatment with whole brain conventional external fractioned irradiation （ DT 19-29 Gy/2-3 w）, 21 days in a period, 2 periods in total. Results The median survival time was estimated to be 6.0 months （ranged from 1.2 to 19.0 months） in the Group Ⅰ , 9.2 months （4.4-30 months） in the Group Ⅱ , and 10.8 months （5.2-42.2 months） in the Group m The 1-year and 2-year survival rates were 34.6% and 12.6% , 62.2% and 30.2%, and 70.8% and 35.6% respectively in GroupⅠ , Group Ⅱ , and Group m respectively. Conclusion For brain metastases of NSCLC, 7-knife plus whole brain conventional external fractioned irradiation combined with treatment of Vm-26 had a significantly beneficial influence on improvement of the local control and 1-year and 2-year survival. There was no complaint about the side-effects of the treatment.

关 键 词：脑转移瘤 Vm-26化疗 伽玛刀 

分 类 号：R734.2[医药卫生—肿瘤]