全脑放疗联合尼莫司汀同步化疗治疗实体肿瘤脑转移的临床观察

Study of whole brain radiotherapy and concurrent with Nimustine chemotherapy for patients with brain metastases from solid tumors

目的:观察全脑放疗联合尼莫司汀同步化疗治疗实体肿瘤伴多发脑转移的疗效及不良反应。方法:对39例实体肿瘤脑转移患者分别采用全脑放疗联合尼莫司汀同步化疗和单纯全脑放疗方案治疗。同步放化疗组:全脑照射(WBRT)为DT2Gy/次,5次/周,总剂量40Gy。放疗开始的第1天同时给予尼莫司汀(ACNU),2mg/kg,d1,每4-6周重复,共使用2-4个疗程。单纯放疗组:全脑照射(WBRT)为DT 2Gy/次,5次/周,总剂量40Gy。放疗结束后3个月评价疗效。结果:同步放化疗组总有效率65.0%(13/20)高于单纯放疗组(42.1%,8/19);神经系统症状改善情况,同步放化疗组优于单纯放疗组;不良反应以放疗脑充血水肿及尼莫司汀引起的骨髓抑制和胃肠道反应为主。结论:全脑放疗联合尼莫司汀同步化疗治疗实体肿瘤脑转移的近期疗效、神经系统症状改善情况优于单纯放疗,不良反应可耐受,可作为实体肿瘤脑转移患者的解救方案。

Objective：To evaluate the efficacy and toxicity of whole brain radiotherapy and concurrent with nimustine chemotherapy for patients with brain metastases from solid tumors.Methods： Thirty-nine patients with brain metastases from solid tumors enrolled in this study.Twenty patients were treated with whole brain radiotherapy concurrent with nimustine and the other 19 patients were treated with whole brain radiotherapy alone.Radiation dose was 40Gy in 20 fractions over 4 weeks.ACNU was administered concurrent with radiotherapy with a dose of 2mg/kg per cycle for 2-4 cycles.Results： Response rate was 65.0% for patients treated with whole brain radiotherapy concurrent with nimustine and 42.1% for patients treated with whole brain radiotherapy（P0.05）.Neurological symptoms improved much better in patients treated with whole brain radiotherapy concurrent with nimustine.Main toxicities of this study were brain edema and digestive/blood toxicity（Ⅰ-Ⅲgrade）.Conclusion： Whole brain radiotherapy concurrent with nimustine is effective and tolerable in patients with brain metastasis from solid tumors,and can be as a salvage regimen.