TP及BCNU同步全脑放射治疗非小细胞肺癌脑转移的临床观察  

Whole brain radiotherapy combined with TP and BCNU regimen in the treatment of NSCLC brain metastasis

作　　者：王涛[1] 张慎锋[1] 尚璇[1] 

机构地区：[1]枣庄市立医院肿瘤中心,山东枣庄277100

出　　处：《中华肿瘤防治杂志》2010年第22期1855-1857,共3页Chinese Journal of Cancer Prevention and Treatment

基　　金：枣庄市科学发展计划(201072)

摘　　要：目的：观察分析TP方案及卡莫司汀（BCNU）同步全脑放射治疗非小细胞肺癌（NSCLC）脑转移的疗效、生存率以及不良反应。方法：32例NSCLC脑转移初治患者接受TP方案,紫杉醇130 mg/m2,24 h持续静脉输注,顺铂（DDP）20 mg/m2,d1~d3,3周为1个周期;脑部放疗与TP方案同时开始,2 Gy/d,5 d/周,脑转移灶1~3个者全脑放疗40 Gy后缩野至60 Gy,脑转移灶〉3个者全脑放疗至40 Gy,放疗开始20 Gy后予BCNU80 mg/m2,d1~d3,6周为1个周期。结果：治疗后84.3%患者神经系统症状得到改善,对脑转移灶有效率为68.7%,对肺原发灶有效率为53.1%,中位总生存期（MST）11.4个月（95%CI为9.48~13.31）,1、2和5年生存率分别为40.6%、18.2%和7.3%,单纯脑转移MST 13.0个月,显著高于多脏器转移9.7个月（P=0.035）。常见不良反应为白细胞减少,Ⅲ~Ⅳ度发生率50.0%,经对症治疗后好转,恶心、呕吐,肌肉关节痛以Ⅰ~Ⅱ度为主。结论：TP方案及BCNU联合全脑放射治疗NSCLC脑转移的近期疗效高并延长了中位生存期,毒副反应耐受性好,可考虑作为NSCLC脑转移的治疗方案。OBJECTIVE：To evaluate efficacy,survival,and safety of concurrent TP and BCNU regimen combined with whole brain radiotherapy in the newly diagnosed NSCLC with brain metastasis.METHODS：Totally 32 newly diagnosed NSCLC were treated with TP regimen,paclitaxel 130 mg/m2 by 24-hour continuous infusion,DDP 20 mg/m2 d1-d3,3 weeks as a cycle.Whole brain radiotherapy began with TP regimen using x-ray at a dose of 2 Gy given in 5 fraction per week.subjects with brain lesions of 1-3 received whole brain radiotherapy at a dose of 40 Gy,then small field to a total dose of 60 Gy.Subjects with brain lesions of more than 3 received whole brain radiotherapy at a dose of 40 Gy.All patients received BCNU after 20 Gy,80 mg/m2 d1-d3,6 weeks as a cycle.RESULTS：this regimen relieved neurological symptoms in 84.3% of the patients.The response rate to brain lesions was 68.7%,to primary lesions was 53.1%.the median survival time（MST） was 11.4 months（95%CI：9.48-13.31）,the 1-,2-and 5-year survival rate were 40.6%,18.2% and 7.3%.The MST of patients with only brain metastasis was 13.0 months,which was longer than the MST of 9.7 months of the patients with other metastasis sites（P=0.035）.Most common toxicities was hematologic,with grade Ⅲ to grade Ⅳ neutropenia seen in 50.0%,most of them were gradeⅠ-Ⅱ.CONCLUSIONS：The efficacy of TP and BCNU regimen combined with whole brain radiotherapy in the newly diagnosed NSCLC with brain metastases is ideal,and all toxicities are well tolerated.So this menthod can be considered as a main regimen in the treatment of NSCLC with brain metastasis.

关 键 词：脑肿瘤 癌 非小细胞肺/继发性 癌 非小细胞肺/药物疗法 癌 非小细胞肺/放射疗法 药物疗法 联合 

分 类 号：R734.2[医药卫生—肿瘤] R739.41[医药卫生—临床医学]