吉非替尼联合放射治疗在非小细胞肺癌脑转移患者治疗中的作用  

Evaluation of gefitinib plus radiotherapy in non-small-cell lung cancer patients with brain metastases

作　　者：傅华[1] 张雪淋[1] 肖瑜[1] 刘小军[1] 龙驰[1] 胡义德[1] 

机构地区：[1]第三军医大学新桥医院全军肿瘤研究所,重庆400037

出　　处：《中华医学杂志》2012年第8期524-527,共4页National Medical Journal of China

基　　金：基金项目：吴阶平医学基金会临床科研专项资助基金（320.6740.10011）

摘　　要：目的 评价吉非替尼联合放射治疗（简称放疗）在非小细胞肺癌脑转移患者治疗中的效果.方法 回顾性分析2001年1月至2010年1月第三军医大学新桥医院全军肿瘤研究所收治的161例非小细胞肺癌脑转移患者的临床资料,其中联合治疗组38例,年龄38～ 77岁,在普通全脑放疗或立体定向放疗的同时服用吉非替尼250 mg,1次/d,连续服用至少8周,于开始服用吉非替尼的第12周进行疗效和毒副反应评价；常规治疗组123例,年龄37—76岁,同期进行普通全脑放疗或立体定向放疗.以x2检验评价两组间客观有效率、疾病控制率、脑转移相关症状及Ⅲ～Ⅳ度毒副反应,以非参数等级检验分析两组美国东部肿瘤协助组体能状态评分（ECOG）间的差异.结果 联合治疗组的客观有效率和疾病控制率分别为31.6％和78.9％,显著高于常规治疗组的15.4％和60.2％,差异均有统计学意义（x2 =4.859,P=0.027和x2=4.479,P=0.034）；脑转移相关症状两组间治疗前无明显差异（X2=2.773,P=0.096）,治疗后联合治疗组的改善率显著高于常规治疗组（X2=4.612,P=0.037）；联合治疗组治疗前ECOG评分等级0～1分18例,2分11例,3～4分9例,治疗后ECOG评分相应等级分别为27、6、5例,治疗后ECOG评分明显好于治疗前（Z=-2.012,P=0.044）；在Ⅲ～Ⅳ度毒副反应中,联合治疗组发生痤疮样皮疹4例,而常规治疗组为0例（P=0.003）,而两组疲乏、恶心呕吐、腹泻、骨髓抑制等的发生差异无统计学意义.结论 吉非替尼联合放疗对提高非小细胞肺癌脑转移患者的近期治疗效果、改善生存质量有一定作用,毒副反应可以耐受.Objective To evaluate the efficacies of gefitinib plus radiotherapy in the treatment of brain metastases in non-small-cell lung carcinoma （NSCLC） patients.Methods A retrospective analysis was conducted for 161 NSCLC patients with brain metastases treated in Xinqiao Hospital from January 2001 to January 2010.And 38 patients aged 38 - 77 years old received the combined regimen of gefitinib plus radiotherapy.It consisted of synchronically practicing general or stereotactic brain radiotherapy and an oral intake of gefitinib （250 mg,QD for at least 8 consecutive weeks）.The efficacies and toxicity were evaluated at Week 12 after the initial treatment.A total of 123 patients aged 37 - 76 years old undergoing whole brain or stereotactic radiotherapy were used as control.X2 test between two groups was carried out to evaluate the objective response rate （ORR）,disease control rate （DCR）,brain metastasis related symptoms and Ⅲ - Ⅳ degree of toxicity. Non-parametric rank tests were performed to compare the U.S. Eastern Cooperative Oncology Group （ECOG） performance status score between two groups. Results In the combination therapy group,the levels of ORR and DCR were significantly higher than those in the conventional treatment group （31.6%,78.9% vs 15.4%,60.2% ）.The differences were statistically significant （ x2 =4.859,P =0.027 and X2 =4.479,P =0.034） ; significant difference existed in brain metastasis-related symptoms between two groups （x2 =4.612,P =0.037） ; the ECOG scores were evaluated in the combination therapy group.And they were as follows：0 - 1 （ n =18 ）,2 （ n =11 ）,3 - 4 （ n =9） at pre-treatment vs 0 - 1 （ n =27）,2 （ n =6）,3 - 4 （ n =5 ） at post-treatment.The ECOG score significantly improved after treatment （Z =-2.012,P =0.044）.Regarding the Ⅲ-Ⅳ degree of toxicity,the combination therapy group had 4 patients with acne-like rash and it was significantly higher than that in the conventional therapy group （ n =0） （P =0.003）.But no differe

关 键 词：癌 非小细胞肺 肿瘤转移 脑 放射治疗 吉非替尼 

分 类 号：R734.2[医药卫生—肿瘤]