全脑放疗联合替莫唑胺治疗脑转移性肿瘤的临床疗效分析

Clinical analysis of whole-brain radiotherapy combined with temozolomide in the treatment of metastatic brain tumor

目的比较全脑放疗联合替莫唑胺化疗与单纯全脑放疗对脑转移性肿瘤疗效以及安全性等方面的差异,优化治疗方案,指导临床应用。方法将台州市肿瘤医院2010年3月—2013年3月收治的40例经增强CT、MRI确诊的脑转移瘤患者,采用随机数字表方式随机分为治疗组和对照组各20例,对照组采用三维适形调强放疗3000 CGY/10F,治疗组在对照组的基础上,加用替莫唑胺75 mg/m2同步化疗14 d。后续治疗按不同原发肿瘤予以相应治疗。随访6个月,采用χ2检验或t检验比较2组患者临床疗效、无进展生存时间及中位生存时间。结果治疗组与对照组患者的有效率(65.0%(13/20)vs.30.0%(6/20),χ2=4.91,P<0.05)、无进展生存时间[(12.1±2.7)月vs.(9.2±2.1)月,t=3.79,P<0.05)]及中位生存时间[(13.5±1.4)月vs.(9.4±1.8)月,t=8.04,P<0.05)]前者均显著高于后者,差异有统计学意义。结论全脑放疗联合替莫唑胺治疗脑转移性肿瘤具有增效作用,且安全可靠,可使患者的生存时间延长,脑转移瘤局部控制率高,患者耐受性好,值得临床推广。

Objective To compare the curative effect and safety of whole-brain radiotherapy combined with temozolomide and whole-brain radiotherapy only in the treatment of metastatic brain tumors,optimize the treatment and guide clinical application. Methods Randomly divided 40 cases of patients who were diagnosed by enhanced CT and MRT as brain metastases from March 2010 to March 2013 into treatment group and control group,20 cases in each. Control group received three-dimensional conformal intensity modulated radiation therapy 3000 CGY /10F,on the basic of it,the treatment group received temozolomide 75 mg / m2concurrent chemotherapy for 14 days. The follow-up treatment carried out according to different primary tumor. Compared the clinical efficacy,progression free survival time（ PFS） and median survival time of the two groups with chi square test or t test at 6 months of follow ups. Results The efficiency [65. 0%（ 13 /20） vs. 30. 0%（ 6 /20）,χ^2= 4. 91,P〈0. 05],progress-free survival time（ 12. 1 ± 2. 7 vs. 9. 2 ± 2. 1,t = 3. 79,P〈0. 05） and median survival time（ 13. 5 ± 1. 4 vs. 9. 4 ± 1. 8,t = 8. 04,P〈0. 05） in the treatment group were significantly higher than the control group. Conclusion It had a synergistic effect and lengthened the survival time to treat metastatic brain tumors with whole-brain radiotherapy combined with temozolomide.