替莫唑胺联合伽马刀在肺癌脑转移治疗中应用

Temozolomide combined with gamma knife in treatment of lung cancer with brain metastasis

目的探讨替莫唑胺联合伽马刀与单纯伽马刀治疗肺癌脑转移的临床疗效。方法选取2012年5月至2014年4月解放军463医院收治的64例肺癌脑转移患者为研究对象。按随机数字表法将患者分为伽马刀组和联合治疗组,每组各32例。伽马刀组患者采用伽马刀治疗,选择12~25 Gy周边剂量进行单次伽马刀治疗。联合治疗组患者于伽马刀治疗同时给予口服替莫唑胺胶囊150 mg/m^2,第1~5天,每天1次,28 d为1个疗程。比较两组患者的临床疗效、肿瘤局部控制率及不良反应发生情况。结果联合治疗组患者治疗总有效率为81.3%,肿瘤局部控制率为90.7%,明显高于伽马刀组的62.5%及84.4%,组间比较,差异均有统计学意义(P<0.05)。两组患者不良反应主要为骨髓抑制及胃肠道反应,不良反应发生率比较,差异无统计学意义(P>0.05)。结论伽马刀联合替莫唑胺治疗肺癌脑转移有较好的疗效和安全性,能有效控制肿瘤进展。

Objective To explore clinical effect of temozolomide combined with gamma knife in treatment of lung cancer with brain metastasis.Methods A retrospective study was performed on 64 patients with lung cancer with brain metastasis who were admitted from May 2012 to April 2014.Patients were randomly divided into the gamma knife group（n = 32） and the combination group（n = 32）.Patients in the gamma knife group were given gamma knife therapy,choosing 12-25 Gy peripheral dose to perform single gamma knife therapy.Patients in the combination group were given gamma knife therapy combined with oral temozolomide 150 mg / m^2,once a day in the first 5 days,28 days as a course of treatment.The clinical effect,tumor locally control rate and adverse reactions were compared between the two groups.Results In the combination group,the total effective rate was 81.3%,tumor locally control rate was 90.7%,which were significantly higher than those（62.5% and 84.4%） in the gamma knife group,the difference between the two groups was statistically significant（P 0.05）.The adverse reactions in the two groups were mainly bone marrow suppression and gastrointestinal reaction,there was no statistically significant difference（P 0.05）.Conclusion Gamma knife combined with temozolomide in treatment of lung cancer with brain metastasis has better efficacy and safety,which can efficiently control the tumor progression.