射波刀联合替莫唑胺治疗非小细胞肺癌脑转移瘤效果分析  

Efficacy of CyberKnife combined with temozolomide in treatment of brain metastasis of non-small cell lung cancer

作　　者：朱其聪[1] 王亚辉[1] 杨琳[1] 郭政军 岳亚丽 胡琅斐 卢静芬 余书勇[1] 

机构地区：[1]解放军第一八七医院肿瘤中心,海口571100

出　　处：《肿瘤研究与临床》2018年第1期17-22,共6页Cancer Research and Clinic

基　　金：海南省卫生和计划生育委员会科学研究基金（琼卫科教[2014]51号）

摘　　要：目的 探讨射波刀联合替莫唑胺（TMZ）治疗非小细胞肺癌（NSCLC）脑转移瘤的有效性和安全性.方法 收集2013年3月至2016年3月解放军第一八七医院肿瘤中心收治的明确诊断的NSCLC脑转移瘤患者62例,按随机数字表法分为两组,射波刀联合TMZ治疗组31例（射波刀＋TMZ组）,单纯射波刀治疗组（射波刀组）31例.射波刀治疗采用低分割照射5～25 Gy/次,1～5次,总剂量18～36 Gy.射波刀＋TMZ组从射波刀治疗第1天起TMZ每天150 mg/m2口服,连用5 d,4周为1个周期,接受6个周期的TMZ治疗,第2个至第6个周期可增至每天200 mg/m2.比较两组射波刀治疗1周后临床症状有效率,治疗后3个月有效率、颅内无进展生存（PFS）时间、总生存（OS）时间以及不良反应.结果 射波刀＋TMZ组和射波刀组在射波刀治疗1周后临床症状有效率分别为93.6％（29/31）、96.8％（30/31）,差异无统计学意义（χ2=1.207,P=0.547）.两组治疗后3个月后病灶有效率分别为93.6％（29/31）、90.3％（28/31）,差异无统计学意义（χ2=0.695,P=0.706）.射波刀＋TMZ组和射波刀组中位颅内PFS时间分别为14.0个月和9.0个月,差异有统计学意义（χ2=8.977,P=0.003）.两组中位OS时间分别为15.0个月和12.0个月,差异有统计学意义（χ2=5.190,P=0.023）.两组的中枢神经系统反应差异无统计学意义（χ2=0.746,P=0.689）,消化系统不良反应（χ2=6.062,P=0.014）及血液学不良反应（χ2=6.613,P=0.010）差异均有统计学意义,但大部分患者能耐受.结论 射波刀联合TMZ可延长NSCLC脑转移瘤的颅内PFS时间及OS时间,不良反应可以耐受,是治疗NSCLC脑转移瘤的较好选择.Objective To analyze the efficacy and safety of CyberKnife combined with temozolomide （TMZ） in treatment of brain metastasis of non-small cell lung cancer （NSCLC）. Methods From March 2013 to March 2016, 62 NSCLC patients with brain metastases in department of oncology of the 187th Hospital of PLA were divided into two groups according to the random number table method, the CyberKnife combined with TMZ group （CyberKnife ＋ TMZ group, 31 cases） and simple CyberKnife group （CyberKnife group, 31 cases）. Hypofractionated radiation of CyberKnife was given 18-36 Gy in 1-5 fractions of 5-25 Gy. CyberKnife＋ TMZ group was given temozolomide 150 mg·m-2·d-1 for 5 days in first cycle, then every 28 days they received temozolomide therapy from the second to the sixth cycles： 200 mg·m-2·d-1 for 5 days. The clinical symptom remission rate after the treatment of CyberKnife in one week, the effective rate after CyberKnife in 3 months, the median intracranial progression-free survival time, overall survival, and the incidences of adverse reaction were comparatively analyzed. Results The clinical symptom remission rates of CyberKnife＋TMZ group and CyberKnife group after the treatment of CyberKnife in one week were 93.6 % （29/31） and 96.8 % （30/31）. There was no significant difference in the clinical symptom remission rates （χ2= 1.207, P=0.547）. The effective rates of the two groups after CyberKnife in 3 months were 93.6 % （29/31） and 90.3 %（28/31）. There was no significant difference in the effective rates （χ2 = 0.695, P= 0.706）. The median intracranial progression-free survival time in CyberKnife ＋ TMZ group （14.0 months） was significantly higher than that in the CyberKnife group （9 months） （χ2=8.977, P=0.003）, and the median overall survival time in CyberKnife ＋ TMZ group （15.0 months） was also significantly higher than that in the CyberKnife group （12.0 months） （χ2 = 5.190, P= 0.023）. There was no significant difference in the adverse reaction of t

关 键 词：癌 非小细胞肺 肿瘤转移 放射疗法 替莫唑胺 射波刀 

分 类 号：R734.2[医药卫生—肿瘤]