替莫唑胺联合全脑放疗治疗非小细胞肺癌脑转移临床研究

Clinical research of TMZ combined treatment with WBRT in the brain metastases patients of NSCLC

目的观察替莫唑胺(temozolomide,TMZ)配合全脑放疗与单纯全脑放疗治疗非小细胞肺癌(NSCLC)脑转移的疗效、生存时间及不良反应。方法将50例NSCLC伴脑转移患者随机分为单纯放疗组(放疗组25例)和放化疗联合组(联合组25例)。放疗组:全脑常规放疗剂量DT4000cGy/4周,对单发转移瘤缩野追加照射DT1 500cGy/1.5周。联合组:放疗方法与单纯放疗组相同,放疗第1天开始给药TMZ 200mg/m^2,第1～5天,28d重复。结果放疗组和联合组总有效率分别为44.0%(11/ 25)和63.3%(19/30)(P<0.05);治疗后中位生存时间放疗组为4.5个月,联合组为8.6个月,两组中位生存时间比较差异有统计学意义(P<0.01),联合组骨髓抑制和胃肠反应高于放疗组,但大部分患者能耐受。结论NSCLC伴脑转移患者行全脑放疗加TMZ可以提高脑肿瘤的局部控制率和延长生存时间。

Objective To study the therapeutic effects of brain metastases from nonsmall-cell lung cancer（NSCLC） by radiotherapy combined with（Temozolomide,TMZ） and raidotherapy alone. Methods fifty cases with brain metastases from NSCLC were randomly divided into 2 groups（25 cases in each group）, including a simple irradiation group receiving whole brain irradiation （WBRT）to a total dose of 4000cGy and a combined group receiving the same radiotherapy plus TMZ. Results The effective rate （63.3%） of combined group was significantly higher than that （44%） of simply irradiation group （P〈0.05）. The middle-survival was 4.5 months in only irradiation group and 8.6 months in combined group respectively with significant difference （P〈0.01）, The side effects including gastrointestinal tract reaction and myelosuppression in combined group was higher than those in irradiation group But ah＇nost all the patients can tolerate the side effects. Conclusion The patients suffered from brain metastases from NSCLC can increase effective rate,and prolong the survival time by whole brain irradiation combincd with TMZ.