全脑照射加拓普替康治疗肺癌脑转移剂量递增试验  

Dose Escalation of Topotecan Combined Whole Brain Radiotherapy for Brain Metastasis of Lung Cancer

作　　者：盖晓惠[1] 刘妙玲[1] 崔桂敏[1] 苑兰惠[1] 杨会彬[1] 史鸿云[1] 张戈妹[1] 

机构地区：[1]河北大学附属医院放疗科,河北保定071000

出　　处：《肿瘤防治研究》2011年第2期152-154,共3页Cancer Research on Prevention and Treatment

摘　　要：目的通过全脑照射加拓普替康每周化疗综合治疗肺癌脑转移,观察其不良反应、耐受剂量及临床可行性。方法 18例肺癌脑转移患者成为研究对象,全程常规分割照射,全脑剂量40Gy/20次,病灶较大者局部加量至50~60Gy。拓普替康的用量从低剂量逐渐上升至高剂量,起始剂量为1.0mg/m2,1次/周,4次,递增剂量为0.25mg/m2,每剂量组至少3例,如无剂量限制毒性（DLT）出现则进入下一剂量组,直至出现DLT,DLT的次一剂量即为最大耐受量（MTD）。结果 DLT为3级放射性骨髓抑制,发生在拓普替康2.0mg/m2剂量水平;则其次一剂量1.75mg/m2即为MTD。主要不良反应为放射性骨髓抑制。结论全脑照射加拓普替康每周化疗治疗肺癌脑转移具有临床可行性;拓普替康的最大耐受剂量为1.75mg/m2。Objective To define the maximum-tolerated dose（MTD） and observe the toxicity and clinical practicality of escalation of topotecan combined whole brain radiotherapy for brain metastasis of lung cancer.Methods Eighteen Chinese patients suffering from brain metastasis of lung cancer received conventional fractionation radiotherapy,with 5 daily fractions of 2 Gy per week,the total radiation dose 40 Gy and the larger add to 50~60 Gy.The starting dose of topotecan was 1.0 mg/m2,Escalation dose was 0.25 mg/m2,Every cohort contained at least 3 patients.If no dose-limiting toxicity（DLT） was observed,the next dose level was opened for entry.These courses were repeated until DLT appeared.MTD was declared as one dose level below which DLT appeared.Results DLT was defined as grade 3 matologic toxicity at the level of topotecan 2.0 mg/m2,The major side effects were matologic toxicity,nausea and vomiting.Conclution Combined whole brain radiotherapy and topotecan for brain metastasis from lung cancer is well tolerted.The maximun tolerated dose of topotecan was 1.75 mg/m2.

关 键 词：肺癌 脑转移 拓普替康 放射治疗 化学治疗 最大耐受剂量 

分 类 号：R730.58[医药卫生—肿瘤] R734.2[医药卫生—临床医学]