厄洛替尼单药与替莫唑胺联合放疗对肺腺癌伴脑转移的临床疗效分析

Clinical Efficacy of Erlotinib Monotherapy or Temozolomide Plus Radiotherapy in the Treatment of Brian Metastasis in lung Adenocarcinoma

目的：探讨厄洛替尼单药与替莫唑胺联合放疗治疗肺腺癌脑转移的有效性和安全性。方法：选择2009年1月～2011年12月我院收治的54例肺癌脑转移患者为研究对象,随机分为厄洛替尼组和替莫唑胺联合放疗组。厄洛替尼组（34例）给予口服厄洛替尼150 mg/d服药直到病情进展或不能耐受副作用,替莫唑胺联合放疗组（20例）给予全脑放疗（40Gy/20次,4周）并同期给予替莫唑胺75 mg·m^-2·d^-1,d1-5 po,放疗后序贯替莫唑胺150mg·m^-2·d^-1,d1-5 po,q28d,共6周期。治疗结束后,分析和比较两组的无进展生存期（PFS）、中位生存期（OS）、总有效率（RR）和疾病控制率（DCR）以及不良反应的发生情况。结果：厄洛替尼组的RR和DCR分别为76.5%和88.2%;替莫唑胺联合放疗组分别为80%和95%,两组比较差异均无统计学意义（P〉0.05）。两组的PFS分别为10.1和7.1个月,差异无统计学意义（P〉0.05）,厄洛替尼组的OS为20.1个月,较替莫唑胺联合放疗组（10.8个月）明显延长,差异有统计学意义（P〈0.05）。两组常见的不良反应为皮疹、骨髓抑制、消化道反应、肝功能损伤等,其中厄洛替尼组和替莫唑胺联合放疗组皮疹的发生率两分别为76.5%和5%,两组比较有统计学差异（P〈0.05）,两组其它不良反应的发生率比较差异均无统计学意义（P〉0.05）。结论：厄洛替尼治疗肺腺癌脑转移的近期疗效与替莫唑胺联合放疗相当,但其可显著延长患者的中位生存期,不良反应轻微。

Objective： We performed this study to compare the efficacy and safety of erlotinib monotherapy or temozolomide plus radiotherapy in treatment of lung adenocarcinoma with brain metastases. Methods： We selected 54 patients with brain metastases of lung adenocarcinoma who underwent treatment in the first affiliated Hospital of Dalian Medical University from January 2009 to December 2011. They were randomly enrolled into two groups： one group treated with erlotinib（34） 150mg daily until disease progression or unacceptable toxicity, and the other group that temozolomide plus radiotherapy group（20）was given temozolomide 75 mg·m^-2·d^-1for 5 days every 28 days and conventional head radiotherapy of total dose of 40 Gy for 20 times for 4 weeks, then they received temozolomide therapy second to the sixth cycles： 150 mg·m^-2·d^-1for 5 days. The progression-free survival（PFS）, median overall survival（OS）, response rate（RR）,disease control rate（DCR） and incidence of adverse reaction were comparatively analyzed. Results：The RR and the DCR of erlotinib group were 76.5% and 88.2%, respectively. The RR and the DCR of temozolomide joint radiotherapy were 80% and 95%, respectively. There were all no significant differences between the two groups（P〉0.05）. The PFS of the two group were 10.1months and 7.1months,respectively（P〉0.05）. OS of the two group were 20.1 months and 10.8 months respectively, and there were significant differences between the two groups（P〈0.05）. The main adverse effects of the two groups are rash, bone marrow suppression, enteron reaction, abnormal liver function and so on. The incidence of rash between erlotinib group and temozolomide plus radiotherapy group were 76.5% and 5%, and there were significant differences between the two groups（P〈0.05）. The other incidence of adverse reaction were no significant differences between the two groups（P〉0.05）. Conclusion： The short-term effect of erlotinib is not superior to temozolomide plus radiotherapy group in treatment of lung adenocarcinoma with brain metastases, but the median survival time was significant prolongation and the toxicity was mild.