VPC方案化疗联合脑部放疗治疗小细胞肺癌脑转移

VPC regimen combined with whole-brain radiotherapy in the treatment of small cell lung cancer with brain meta- stasis

背景与目的 放射治疗是治疗脑转移的主要手段,而到目前为止化疗与放疗联合治疗脑转移的研究较少。本研究旨在评价VPC(鬼臼噻吩甙+顺铂+司莫司汀)方案化疗联合脑部放疗治疗小细胞肺癌(small cell lung cancer, SCLC)脑转移患者的近期疗效及不良反应。方法 60例SCLC脑转移患者接受VPC方案化疗。脑部放疗于化疗第一周期的第6天开始,全脑照射剂量为30 Gy。残留病灶≤3个时,行缩野追加剂量20 Gy;残留病灶>3个时,继续全脑追加剂量10 Gy。化疗至少2周期及脑部放疗结束后,行脑部和胸部CT或MRI评价疗效。结果 全组60例患者均按计划完成脑部放疗与化疗,其中52例对残留病灶完成缩野治疗。治疗后全组肺部原发灶的有效率为46.7%(28/60);脑部病灶总有效率为60.0%(36/60)。48 例治疗前有神经系统症状和体征的患者均有不同程度的改善。不良反应有骨髓抑制、胃肠道反应、便秘和脱发。随诊率93.3%,中位生存期11.3个月,1年生存率为43.3%,2年生存率为35.0%,5 年生存率为6.7%。结论 化疗联合脑部放疗治疗SCLC脑转移,毒性反应轻,患者能够接受,近期疗效较理想。

Background and objective The main treatment strategy of cancer patients with brain meta- stasis is irradiation, while so far there is few research concerning chemotherapy combined with radiotherapy for these patients. The aim of this study is to evaluate the therapeutic effect and toxicity of chemotherapy with VPC regimen combined with whole-brain radiotherapy (WBRT) in small cell lung cancer (SCLC) with brain metastasis. Methods A total of 60 SCLC patients with brain metastasis received a cycle of VPC regimen (teniposide 60mg/m 2 iv on days 1--5, cisplatin 35mg/m 2 iv on days 1--3, semustine 80mg/m 2 PO on day 1) every 3--4 weeks. WBRT was administered on day 6 of the first cycle of chemotherapy at a dose of 2Gy given in 5 fractions per week. Patients with less than 3 brain lesions received WBRT at a dose of 30Gy and then small field radiotherapy up to total dose of 50Gy, otherwise they received WBRT at a total dose of 40Gy. Response was evaluated by brain and chest CT or MRI after WBRT and at least 2 cycles of chemotherapy were completed. Results All the patients completed WBRT combined with chemotherapy. Total response rate of primary pulmonary tumor was 46.7%, with 4 cases of CR. The objective brain response rate was 60.0%, with 11 cases of CR and 25 cases of PR. Symptom relief was observed in all 48 patients with neurological symptoms. Main adverse effects were myelotoxicity, nausea/vomiting, constipation and alopecia. The follow-up rate was 93.3% with a median survival duration of 11.3 months. The 1-, 2- and 5-year survival rate was 43.3%, 35.0% and 6.7%, respectively.Conclusion Chemotherapy combined with WBRT can be safely performed for SCLC with brain metastasis and its short-term response is quite satisfactory. It may be worthy of further clinical investigation.