EGFR-TKI联合全脑放疗对非小细胞肺癌脑转移的临床观察

目的评价非小细胞肺癌（NSCLC）表皮生长因子受体（EGFR）-酪氨酸激酶抑制剂（TKI）联合全脑放疗的临床疗效和安全性。方法23例NSCLC脑转移患者采用三维适形或调强放疗，脑转移灶予全脑放疗30Gy／10次或40Gy／20次，若是单发脑转移灶再局部缩野加量10-20Gy／5-10次。同期口服EGFR-TKI（埃克替尼125mg3次／d或吉非替尼250mg1次／d），放疗结束后继续口服GFR-TKI，直至疾病进展、死亡或出现不可耐受的不良反应。结果完全缓解2例（8．7％），部分缓解17例（73．9％），无变化3例（13％），进展1例（4．3％），总有效率82．6％。主要的不良反应有皮疹、皮肤瘙痒、白细胞减少、放射性脑病、贫血、乏力及腹泻等，多为轻度。结论采用适形或调强放疗联合EGFR-TKI治疗NSCLC脑转移有较好的近期疗效及生存状态，不良反应轻微，可以作为NSCLC脑转移的一种治疗选择。

Objective To evaluate the clinical effects of whole brain radiotherapy combine with EGFR-TKI for the brain metastases from nonsmall-cell lung cancer. Methods 23 cases of non small cell lung cancer with brain metastases have been given three-dimensional conformal or intensitymodulated radiotherapy, and brain metastases were treated with whole brain radiotherapy （ 30Gy/10 or 40Gy/20 times ） , however, for the single brain metastasis without local shrinkage, the radiotherapy was added with 10-20 Gy/5-10 times. Meanwhile they oraled EGFR-TKI （ lcotinib 125mg daily 3 times or gefitinib 250mg daily 1 times ） . After the radiotherapy, they needed to continue taking EGFR-TKI orally, until the disease worsen step by step, the intolerable adverse reactions appeared or death. Results 2 was complete anesis （ 8.7% ） , 17 partial anesis （ 73.9% ） , 3 no change （ 13% ） , and only 1 worsen （ 4.3% ） , the total efficiencal percentage is 82.6%. The main adverse reactions were rash, skin itching, white blood cells decline, radiation encephalopathy, anemia, fatigue and diarrhea, mostly mild. Conclusion The use of conformal or intensity modulated radiation therapy combined with EGFR-TKI in the treatment to non small cell lung cancer patients with brain metastases has better short-term efficacy and survival, adverse reactions decline, so it is a better therapeutic method for non small cell lung cancer with brain metastasis.