非小细胞肺癌脑转移TP及BCNU同步放疗疗效观察  

Effects of concurrent TP and BCNU regimen combined with radiotherapy in the treatment of brain metastases of NSCLC

作　　者：孙洁[1] 余金喜 严广华[1] 

机构地区：[1]枣庄市立医院,山东枣庄277100 [2]枣庄矿业集团中心医院,山东枣庄277011

出　　处：《中国医院药学杂志》2011年第23期1967-1969,共3页Chinese Journal of Hospital Pharmacy

摘　　要：目的:观察分析同步TP方案及BCNU放疗治疗非小细胞肺癌(NSCLC)脑转移的疗效、生存率以及不良反应。方法:36例NSCLC脑转移初治患者接受TP方案,紫杉醇130 mg.m-2,24 h持续静脉输注,顺铂(DDP)20 mg.m-2,D1～D3,3周为1个周期;脑部放疗与TP方案同时开始,2 Gy.d-1,每周5 d,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后予卡莫司汀(BCNU)80 mg.m-2,D1～D3,6周为1个周期。结果:治疗后84%患者神经系统症状得到改善,对脑转移灶有效率为58.4%,对肺原发灶有效率为55.5%,中位总生存期(MST)11.2个月(95%CI 9.58～13.30),1年生存率为40.2%,2年生存率17.2%,5年生存率为7.1%,单纯脑转移MST13.0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%,经对症治疗后好转,恶心、呕吐,肌肉关节痛以Ⅰ～Ⅱ度为主,发生率均为16.7%。结论:TP方案及卡莫司汀联合全脑放射治疗NSCLC脑转移的近期疗效高并延长了中位生存期,不良反应耐受性好,可考虑作为NSCLC脑转移的治疗方案。OBJECTIVE To evaluate the efficacy, survival rate and safety of concurrent TP and BCNU regimen combined with whole brain radiotherapy in the newly diagnosed NSCLC with brain metastases. METHODS Among the 36 newly diag nosed NSCLC with brain metastases,6 subjects were squamous cell carcinoma, 30 subjects were adenocarcinoma. All patients were treated with TP regimen, paclitaxel 130 mg.m 2 by 24-hour continuous infusion, DDP 20 mg.m 2 on 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·m 2 on d1 - d3, 6 weeks a cycle. RESULTS The regimen relieved neurological symptoms in 84% of the patients. The response rate to brain lesions was 58. 4%, to primary lesions was 55.5%. The median survival time （MST） was 11.2 months （95 % CI 9. 48 - 13. 31 ）, the 1, 2 and 5 years survival rates were 40. 2%, 17. 2 %and 7. 1%, respectively. The MST of patients with only brain metastasis was 13 months, longer than patients with other metastasis sites, for which the MST was 9 months （P = 0. 035）. Most toxicities was hematologic, neutropenia, with grade Ⅲto grade Ⅳ, which were commonly occurred in 50% of patients, vomit, 16. 7%, myalgia, of grade Ⅰ-Ⅱ ,16. 7%. CONCLUSION The TP and BCNU regimen combined with whole brain radiotherapy were effective and well tolerable in newly diagnosed NSCLC with brain metastases, and can be considered as a main regimen in the treatment of NSCLC with brain metastasis.

关 键 词：脑转移 非小细胞肺癌 放疗 卡莫司汀 

分 类 号：R969[医药卫生—药理学]