厄洛替尼联合全脑放疗治疗肺腺癌伴脑转移的临床观察  

Clinical observation of erlotinib combined with whole brain radiotherapy for lung adenocarcinoma with brain metastases

作　　者：顾红芳[1] 许春明[1] 王向前[1] 蔡晶[1] 夏小春[1] 杨百霞[1] 朱琪伟[1] 

机构地区：[1]南通市肿瘤医院放疗科,江苏南通226361

出　　处：《临床肿瘤学杂志》2014年第12期1118-1122,共5页Chinese Clinical Oncology

摘　　要：目的探讨厄洛替尼联合全脑放疗（WBRT）治疗肺腺癌伴脑转移的临床疗效及不良反应。方法选取2011年1月至2012年6月我院收治的肺腺癌伴脑转移患者42例,随机分为治疗组（n=22）和对照组（n=20）。治疗组患者给予厄洛替尼150mg口服,每日1次;同时行WBRT,总剂量为30~36Gy/10~12次,3Gy/次,5次/周,若脑转移病灶为1~2个,WBRT 30~36Gy后,缩野脑转移灶加量16~20Gy/8~10次/2周。对照组患者先行全身化疗2个周期,然后行WBRT,放疗方法同治疗组。ECOG评分为0~1分患者采用AP方案（培美曲塞500mg/m2,第1天;顺铂25mg/m2,静脉滴注,第1~3天）或DP方案（多西他赛75mg/m2,第1天;顺铂25mg/m2,静脉滴注,第1~3天）,ECOG评分2分患者给予单药培美曲塞化疗,21天为1个周期。观察两组患者的近期疗效、不良反应及生存情况。结果 42例患者均可评价疗效。治疗组和对照组脑转移灶的RR分别为86.4%、70.0%,差异无统计学意义（P〉0.05）。治疗组和对照组肺癌原发灶的RR分别为40.9%、35.0%,差异无统计学意义（P〉0.05）。治疗组和对照组的中位TTP分别为8.5个月和4.5个月,差异无统计学意义（P〉0.05）。治疗组和对照组的中位OS分别为14.0个月和9.8个月,差异无统计学意义（P〉0.05）。治疗组和对照组的1年生存率分别为59.1%和45.0%,2年生存率分别为27.3%和15.0%,差异均无统计学意义（P〉0.05）。治疗组不良反应仅为皮疹和腹泻,多数为1~2级,患者可耐受,无明显骨髓抑制或消化道反应;对照组主要为骨髓抑制、恶心和呕吐等消化道反应,经对症处理后好转。结论厄洛替尼联合WBRT治疗肺腺癌伴脑转移能延长患者的生存时间,且患者耐受性良好。Objective To investigate the efficacy and side effects of erlotinib plus whole brain radiotherapy（ WBRT） in the treatment of lung cancer with brain metastases. Methods Forty-two cases of lung cancer with brain metastases patients from January2011 to June 2012 in our hospital were randomly divided into treatment group（ n = 22） and control group（ n = 20）. 22 patients in treatment group were treated with erlotinib 150 mg orally,once per day,combined with WBRT with total dose of 30 ~ 36 Gy,3Gy per fraction,five times per week. If the number of brain metastatic lesions were 1-2,shrinkage wild of brain metastases should need extral 16-20 Gy /8-10 times after WBRT. Twenty patients in control group were received chemotherapy for 2 cycles（ 21 days was a cycle）,and then treated with WBRT,with the same dose and method to treatment group. Patients with ECOG scored 0-1 points were treated by AP or DP solutions. Patients with ECOG scored 2 points were treated with pemetrexed chemotherapy. The curative effects,the survival rate and adverse reaction of two groups were observed and evaluated. Results A total of 42 patients could be evaluated. The RR of brain metastases in treatment group and control group was 86. 4% and 70. 0%,respectively（ P 〉 0. 05）. The RR of lung primary tumor in treatment group and control group was 40. 9% and 35. 0%,respectively（ P 〉 0. 05）. The median progress free survival was 8. 5months in treatment group and 4. 5 months in the control group（ P 〉 0. 05）. The median survival time was 14. 0 months in the treatment group and 9. 8 months in the control group（ P 〉 0. 05）. 1-year survival rate of two groups were 59. 1% and 45. 0%,and 2-year survival rates were 27. 3% and 15. 0%,respectively. They were no statistically significant difference（ P 〉 0. 05）. The main adverse reactions in treatment group were only rash and diarrhea,mostly gradeⅠ-Ⅱ,which could be tolerated. The obvious bone marrow suppression and gastrointestinal side effects had no occurrence. In the

关 键 词：厄洛替尼 全脑放疗 肺腺癌 脑转移 

分 类 号：R734.2[医药卫生—肿瘤]