替莫唑胺对小细胞肺癌脑转移的预防作用

The preventive effect of temozolomide on brain metastases from small-cell lung cancer

目的探讨替莫唑胺维持化疗对小细胞肺癌脑转移的预防作用。方法采用前瞻、对照研究,将初治放化疗后达到完全缓解或部分缓解的小细胞肺癌患者50例分为治疗组(n=30)和对照组(n=20)。治疗组在放化疗结束后使用替莫唑胺维持化疗,对照组行预防性全脑照射(PCI)。统计分析两组患者脑转移阳性率,总生存期及1年生存率。分别记录两种治疗方案发生的不良反应。结果替莫唑胺化疗组与PCI组脑转移阳性率差异无统计学意义(16.7% vs.15.0%,P>0.05)。替莫唑胺化疗组患者中位生存时间为31个月,1年生存率为86.3%;PCI组患者中位生存时间为24个月,1年生存率为79.1%;二者生存情况差异无统计学意义(P>0.05)。替莫唑胺化疗组不良反应主要是血液学反应及胃肠道反应,均为轻、中度。PCI组急性反应主要为头晕恶心,部分患者发生远期神经系统不良反应。结论替莫唑胺维持化疗对降低小细胞肺癌脑转移率的疗效不差于传统PCI治疗,且不良反应为轻、中度,安全可行。

Objective This study aimed to explore the preventive effect of temozolomide on brain metastases from small-cell lung cancer. Methods A total of 50 patients with small-cell lung cancer who achieved complete remission or partial response after radiation and chemotherapy were divided into treatment group and control group. 30 patients of the treatment group received maintain chemotherapy using temozolomide. 20 patients of the control group received prophylactic cranial irradiation（PCI）. The brain metastases positive rate, overall survival rate and 1 year survival rate were analyzed. The adverse reactions of the two treatments were recorded. Results There were no significant differences between temozolomide chemotherapy group and PCI group in brain metastases positive rate（16.7% vs. 15.0%, P〉0.05）. There were no significant differences of the overall survival rate and 1 year survival rate between the two groups（31 months vs. 24 months, 86.3% vs. 79.1%, P〉 0.05）. The adverse reactions of temozolomide chemotherapy group were mainly hematology and gastrointestinal reaction which was mild to moderate. The acute reactions of PCI group were mainly dizziness and nausea, and some patients had long-term nervous system adverse reaction. Conclusion The effect of temozolomide on maintaining chemotherapy to reduce brain metastasis from smallcell lung cancer is not worse than the traditional treatment of PCI and it is safe and feasible.