替莫唑胺联合同步放疗对肺癌脑转移的临床观察  

Efficacy of temozolomide combined with concurrent whole brain radiotherapy for lung cancer with brain metastases

作　　者：张渝[1,2] 陶海涛[1,2] 汪进良[1] 马俊勋[1] 董伟伟[1] 胡毅[1] 

机构地区：[1]解放军总医院肿瘤内一科,北京100853 [2]南开大学医学院,天津300100

出　　处：《中国药物应用与监测》2015年第3期133-136,共4页Chinese Journal of Drug Application and Monitoring

基　　金：军队保健专项课题(14BJZ04)

摘　　要：目的：评价替莫唑胺联合同步全脑放疗对肺癌脑转移患者的有效性和安全性。方法：收集替莫唑胺联合全脑放疗治疗肺癌脑转移患者24例，全脑放疗总剂量40 Gy，2 Gy/次，5次/周。全脑放疗后，对部分局部病灶三维适形局部加量至50-60 Gy。所有患者于放疗第1天开始给予替莫唑胺75 mg·m-2口服治疗，直至放疗结束，如有不良反应不可耐受则停用化疗药。后续根据患者的系统治疗和耐受情况，患者在放疗结束后接受系统化疗或继续替莫唑胺辅助治疗（150-200 mg·m-2·d-1，5/28天），最多行6周期辅助治疗，评价患者的疗效与不良反应。结果：24例患者全部完成颅脑的同步放化疗，10例患者接受个体化选择的系统化疗，7例接受最佳支持治疗，3例患者接受4个周期替莫唑胺辅助治疗，3例患者接受了6周期辅助治疗。放化疗结束后颅内病灶评价：完全缓解2例，部分缓解7例，稳定12例，进展3例，总有效率37.5%，疾病控制率87.5%，中位PFS为5个月，中位颅内病灶PFS为6个月。18例患者出现治疗相关不良反应，其中3例（12.5%）出现Ⅲ~Ⅳ度血液学毒性反应。4例（16.7%）出现Ⅲ~Ⅳ度非血液学毒性反应。结论：替莫唑胺联合全脑放疗治疗肺癌脑转移疗效较满意，不良反应可耐受，治疗依从性较好，远期生存获益仍需进一步的临床研究予以验证。Objective：To assess the efifcacy and safety of temozolomide （TMZ） combined with whole brain radiotherapy in the treatment of lung cancer patients with brain metastases.Methods：A total of 24 lung cancer patients with brain metastases were enrolled in this retrospective study. The whole brain radiotherapy with the total dose of 40 Gy （2 Gy per time, 5 times per week） was given to all the patients, and another 10–20 Gy of intensity-modulated boosting therapy for local lesion was given if necessary. All patients took temozolomide （75 mg·m-2） concurrently during the whole course of radiotherapy. Temozolomide should be stopped, if the patient can not tolerate adverse reactions. After radiotherapy, the patients received systematical chemotherapy or continued TMZ therapy （150–200 mg·m-2·d-1, 5/28 d） for additional 0–6 cycles according to the condition of the patients. The efifcacy and adverse reactions were evaluated statistically.Results：All the patients ifnished the radiotherapy combined with concurrent TMZ. Afterwards, 10 patients received systematical chemotherapy, 7 patients received the best supportive treatment, 3 patients received additional 4 cycles of TMZ adjuvant therapy, and 3 patients continued 6 cycles of TMZ chemotherapy. After radiotherapy and chemotherapy, 2 patients had complete response, 7 patients had partial response, 12 patients had stable disease, while the other 3 patients had progressed disease by evaluation of intracranial lesion. Therefore, the total effective rate achieved 37.5%, the disease control rate obtained 87.5%, the median PFS was 5 months, the median intracranial lesions PFS was 6 months. Acute side-effects were developed in 18 patients. GradeⅢorⅣhematologic toxicities were developed in 3 patients （12.5%）, but gradeⅢ–Ⅳnon-hematologic side-effects were developed in 4 patients （16.7%）.Conclusion：Temozolomide was well tolerant, and showed signiifcant improvements in response rate when combined with whole brain radiotherapy in lung cancer

关 键 词：替莫唑胺 全脑放疗 脑转移 肺癌 

分 类 号：R734.2[医药卫生—肿瘤]