三维适形放疗联合埃克替尼或厄洛替尼治疗老年肺腺癌EGFR突变脑转移的疗效观察

Efficacy of three-dimensional conformal therapy combined with icotinib or erlotinib in elderly and advanced lung adenocarcinoma patients with EGFR mutations and brain metastases

目的 观察三维适形放疗联合埃克替尼与厄洛替尼治疗老年肺腺癌EGFR突变脑转移患者的临床疗效和安全性。方法 选择2011年11月至2013年11月我科收治的老年晚期肺腺癌脑转移患者76例,均合并EGFR突变。随机分为2组,治疗组38例,给予埃克替尼（125mg,3次/d）,同步三维适形放疗,肺原发灶及肺内转移灶剂量36-60Gy（2.0Gy/次,1次/d,5次/周）,脑转移灶先行全脑放疗30-40Gy（2Gy/次,1次/d,5次/周）,再缩野局部加量10-20Gy（2.0Gy/次,5次/周）;对照组38例,厄洛替尼（150mg,1次/d）三维适形放疗同治疗组,直到疾病进展或出现严重不良反应,接受2个以上周期治疗后,评价2组疗效和不良反应。结果 全部病例均可评价,治疗组和对照组有效率（RR）分别为63.2%和57.9%,中位无进展时间分别为9.9月和9.0月,两组临床受益反应率分别为68.4%和60.5%;亚组分析显示,两组不同EGFR突变类型的中位无进展时间分别为11.2月和10.6月（19外显子缺失）,8.7月和7.9月（21外显子突变）,差异均无统计学意义（P〉0.05）;两组主要毒副作用为皮疹、白细胞减少、恶心呕吐、放射性食管炎、腹泻,均可耐受,差异无统计学意义（P〉0.05）。结论 三维适形放疗联合埃克替尼或厄洛替尼治疗老年肺腺癌EGFR突变脑转移患者的疗效无统计学差异,均可耐受。

Objective To observe the clinical efficacy and safety of three-dimensional conformal therapy combined with icotinib or erlotinib in elderly and advanced lung adenocarcinoma patients with EGFR mutations and brain metastases. Methods Seventy-six elderly and advanced lung adenocarcinoma patients with EGFR mutations and brain metastases treated in our departments between November 2011 and November 2013 were randomly divided into two groups. Thirty-eight patients in treatment group received three-dimensional conformal radiation including primary tumors and metastases combined with icotinib （125mg, tid, po）, and the dose for pulmonary primary tumors and lung metastases was 36-60Gy （2Gy/d, 5d/week）, and for brain metastases the dose of whole brain radiotherapy was 30-40Gy （2Gy/d, 5d/week）, then increased dose of IMRT was 10-20Gy （2Gy/d, 5d/week）. Thirty-eight ones in the control group were treated with the same radiation regimen and erlotinib （150mg, qd, po）. The efficacy and toxicity were evaluated after two cycles. Results The efficacy and toxicity could be evaluated in the 78 cases. The overall response rates were 63.2% and 57.9%, and the median progression free survival （PFS） was 9.9 and 9.0 months. Subgroup analysis showed that PFS in the two groups with different EGFR mutations was 11.2 and 10.6 months （19 exon deletion）, 8.7 and 7.9 months （21 exon mutation）, respectively, without significant difference （P〉0.05）. The most common toxicities of the two groups were rash, leukopenia, diarrhea and hepatic injury, which could be tolerated, with no significant difference （P〉0.05）. Conclusion Three-dimensional conformal therapy combined with icotinib or erlotinib in elderly and advanced lung adenocarcinoma patients with EGFR mutations and brain metastases has similar outcome and tolerance, thus being worthy of clinical application.