血脑屏障通透性最大化时间窗指导非小细胞肺癌多发脑转移治疗的价值分析

The value analysis of blood brain barrier permeability in the treatment of multiple brain metastases patients with non-small cell lung cancer

目的:探讨血脑屏障通透性最大化时间窗指导非小细胞肺癌多发脑转移治疗的价值。方法:采用回顾性研究方法,研究时间为2012年8月到2015年12月,选择在我院诊治的非小细胞肺癌多发脑转移患者90例,根据肿瘤放射治疗组(RTOG)脑转移瘤的独立递归分级指数(RPA)进行分层,分为A、B、C三组各30例。A组在放化疗开始前1周应用重组人血管内皮抑制素(恩度)治疗,全脑放疗至30 Gy时开始静脉化疗;B组在放化疗开始时同步应用恩度治疗,全脑放疗至30 Gy时开始静脉化疗;C组在放化疗开始时同步应用恩度治疗,全脑放疗并同步给予化疗,评价三组预后情况。结果:A组、B组与C组的有效率分别为66.7%、46.7%和26.7%,A组最高、B组次之、C组最低,两两对比差异都有统计学意义(P<0.05)。三组最常见毒副反应主要表现为白细胞下降、腹泻、恶心呕吐、肝功能损害等,发生率分别为66.7%、66.7%和63.3%,两两对比都无明显差异(P>0.05)。A组、B组与C组治疗后的KPS评分分别为(67.24±7.39)分、(56.30±5.20)分和(48.20±8.14)分,A组、B组与C组的无进展生存期分别为(11.35±4.20)个月、(9.23±4.11)个月和(7.40±3.22)个月,生存期分别为(18.34±5.13)个月、(16.02±3.89)个月和(13.98±4.11)个月,两两对比差异都有统计学意义(P<0.05)。结论:非小细胞肺癌多发脑转移患者使用恩度后1周能产生一个特定的时间窗,然后全脑放疗至30 Gy后血脑屏障通透性达到最大化,可提高脑内化疗药物血药浓度,从而提高治疗疗效,改善患者的预后生存时间,延长生存期,且不会增加毒副反应的发生。

Objective： To investigate the value of blood brain barrier permeability in the treatment of multiple brain metastases of non - small cell lung cancer. Methods：Used a retrospective study,from the August 2012 to December 2015 ,90 multiple brain metastases patients with non - small cell lung cancer in the diagnosis and treatment of our hospital were selected,and were equally divided into group A,B,C with 30 patients respectively accorded to the radia-tion therapy oncology group （ RTOG） independent recursive grading index. Group A was given the recombinant human vascular endothelial inhibin （ Endostar） treatment before the chemoradiotherapy about 1 week,and intravenous chem-otherapy was started when the whole brain radiotherapy was 30 Gy. Group B was given Endostar and chemoradiothera- py at the same time,and synchronous intravenous chemotherapy,when whole brain radiotherapy was to 30 Gy. Group C was given the chemoradiotherapy when the Endostar was started,and chemotherapy was did when whole brain ra-diotherapy was started. Prognosis of three groups were evaluated. Results：The efficiency in the group A,B,C were 66. 1% ,46.1% and 26. 7% with significant difference （ P 〈 0. 05 ） . The most common side effects of the three groups include white blood cell decline, diarrhea, nausea, vomiting, liver function damage, and the incidence rates in the group A, B, C were 66. 1% ,66. 1% and 63. 3% respectively, with no significant difference （P 〉 0. 05 ） . The KPS score after treatment in the group A, B, C were （67. 24 ±7. 39） points, （56. 30 ±5. 20） points and （48. 20 ± 8. 14） points. The progression free survival time in the group A, B, C were （ 11.35 ±4. 20） months, （9. 23 ±4. 11） months and （7. 40 ± 3. 22） months and survival time were （ 18. 34 ± 5. 13 ） months,（ 16. 02 ± 3. 89） months and （ 13. 98 土 4.11） months with significant difference （ P 〈 0. 05 ） . Conclusion ： Endostar used after 1 week can produce a specific time window in the multiple brain metastases patients with non - small cell lung cancer,and then the whole brain ra-diotherapy to 30 Gy can reach maximum of permeability of blood brain barrier,which can improve brain chemotherapy drug blood concentration, so as to improve the curative effect, improve the prognosis of patients with prolonging the survival time,and it will not increase the occurrence of adverse reactions.