多西紫杉醇和顺铂联合全脑放疗治疗非小细胞肺癌脑转移的疗效

Efficacy of Docetaxel and DDP with Whole Brain Radiotherapy in the Treatment of Non-Small Cell Lung Cancer Patients with Brain Metastasis

目的探讨多西紫杉醇和顺铂联合全脑放疗,治疗非小细胞肺癌脑转移的近期疗效及患者生存期和生存质量。方法将40例非小细胞肺癌脑转移患者随机分为A组和B组,各20例。A组,采用"多西紫杉醇+卡铂"方案:多西紫杉醇75 mg/m2,d1;顺铂40 mg/m2,d1～2。B组,采用"替尼泊甙+顺铂"方案:替尼泊甙60 mg/m2,d1～5;顺铂40 mg/m2,d1～2。每21天为1个周期。脑部放疗:6MV-X线直线加速器,脑部病灶≤3个,全脑放疗40 Gy/20次后,根据情况缩野加量14～16 Gy/7～8次;脑部病灶>3个,全脑放疗至40 Gy/20次。全脑放疗至20～30 Gy/10～15次时同时行化疗。结果对脑转移的控制有效率(CR+PR)A组为70.0%(14/20),B组为65.0%(13/20),两组比较无显著性差异(P>0.05);中位生存期两组分别为14和9个月;中位肿瘤进展时间(mTTP)分别为9.7和6.3个月,两组比较有显著性差异(P<0.05);1年生存率两组分别为65.0%(13/20)和30.0%(6/20),两者比较有显著性差异(P<0.05)。两组治疗前后KPS评分比较,差异有统计学意义。结论多西紫杉醇和顺铂联合全脑放疗对非小细胞肺癌脑转移控制率无明显提高,但延长了患者生存期及肿瘤进展时间(TTP),具有较好疗效。

Objective To explore the short term effect,survival time and life quality of docetaxel and DDP with whole brain radiotherapy in the treatment of Non-small cell lung cancer patients with brain metastasis.Methods 40 cases of Non-small cell lung cancer with brain metastasis were randomized into two groups,20 cases in Group A and 20 cases in Group B.Patients in group A were treated by docetaxel 75 mg/m2,d1;DDP 40 mg/m2,d1~2,and patients in group B,received VM26 60 mg/m2,d1~5;DDP 40 mg/m2,d1~2.Whole brain irradiation was given to the 2 groups by using 6MV-X linear accelerator.For Patients with brain lesions≤3,14~16 Gy boost dose was given after 40 Gy of whole brain radiotherapy,whereas patients with more than 3 brain lesions received whole brain radiotherapy alone of 40 Gy.Chemotherapy was given to patients when the whole brain received 20-30 Gy.Results The local control rates of brain metastases（CR＋PR）were 70.0%（14/20）in Group A and 65.0%（13/20） in Group B,there were no significant differences between two groups（P〉0.05）;The median surial period were 14 months and 9 months,The median time to progression（mTTP） were 9.7 months and 6.3 months,there were significant differences between two groups（P〈0.05）;The one year survival rate was 65.0%（13/20） and 30.0%（6/20）,there were significant differences between two groups（P〈0.05）.The KPS scores were significantly different between pre-and post-treatment for the two groups.Conclusion The local control rates were not improved obviously by docetaxel and DDP with whole brain radiotherapy in the treatment of Non-small cell lung cancer patients with brain metastasis,but prolonged the survival period and the time to progression（TTP）,had a better therapeutic effect.