同期推量调强放疗联合替莫唑胺治疗脑转移瘤的疗效观察

Simultaneous Integrated Boost Intensity Modulated Radiotherapy Combined with Concurrent Temozolomide in Treatment of Brain Metastases

[目的]评价同期推量调强放疗(SIB-IMRT)联合替莫唑胺(TMZ)治疗脑转移瘤的临床有效性和安全性。[方法]采用同期推量调强放疗联合替莫唑胺治疗经原发灶病理诊断的脑转移瘤患者83例。全脑放疗30Gy/10F,同期脑转移灶推量调强放疗50Gy/10F,放疗第一天开始口服替莫唑胺75mg/(m^2·d),连续14天,放疗结束后1个月继续予6个周期替莫唑胺辅助化疗,150mg/(m^2·d),连用5天,28天为1个周期。[结果 ]近期有效缓解率(RR)为91.56%,中位生存期为14.38个月,1年总生存率为63.85%。对预后因素行单因素和多因素分析显示KPS评分及脑转移个数对总生存有影响(P<0.05)。Ⅰ度和Ⅱ度中性粒细胞下降的比例为56.63%,Ⅰ度血小板下降的比例为24.1%,Ⅰ度和Ⅱ度恶心呕吐的比例为72.29%,Ⅰ度和Ⅱ度头痛的比例为62.66%,无Ⅳ度不良反应。[结论]同期推量调强放疗联合替莫唑胺治疗脑转移瘤可延长生存时间,不良反应轻。但是,同期推量调强放疗联合替莫唑胺治疗脑转移瘤的治疗是否可以成为脑转移治疗的一种有效方法,还需进一步的临床随机对照试验证实。

[Objective] To evaluate the clinical efficacy and safety of simultaneous integrated boost intensity modulated radiotherapy（SIB-IMRT） combined with concurrent temozolomide（TMZ）in treatment of brain metastases.[Method] Eighty three patients with brain metastases treated by SIB-IMRT combined with concurrent temozolomide were enrolled.Intensity modulated radiation30Gy/10 F was given to brain metastatic lesion and the dose for whole brain radiotherapy was30Gy/10 F.On the first day of radiotherapy,oral temozolomide was given at a dose of 75mg/m2for14 consecutive days.After one month of radiation therapy patients continued to receive 6 cycles of temozolomide adjuvant chemotherapy[150mg/（m2·d） for 5d with 28 d as a cycle].[Results] The short-term effective rate,median survival time and 1-year overall survival rate was 91.56%,14.38 months and 63.85%,respectively.The univariate and multivariate analysis showed that KPS score and numbers of brain metastases were associated with overall survival（P〈0.05）.The incidence rates of leucopenia grade Ⅰ/Ⅱ,thrombocytopenia grade Ⅰ,nausea and vomiting grade Ⅰ/Ⅱ and headache gradeⅠ/Ⅱ were 56.63%,24.1%,72.29% and 62.66%,respectively.There was no gradeⅣ bone marrow suppression observed.[Conclusion] SIB-IMRT combined with concurrent TMZ may prolong the survival time without serious adverse reactions for patients with brain metastases.However,further randomized controlled clinical trials are still needed.