放疗联合替莫唑胺同步和序贯治疗小细胞肺癌脑转移患者的临床分析

Clinical Analysis of Radiotherapy Combined with Temozolomide in the Treatment Of Patients with Small Cell Lung Cancer with Brain Metastases

目的临床研究探讨放疗联合替莫唑胺同步和序贯治疗小细胞肺癌脑转移患者的临床分析。方法对该院2015年1月—2016年8月胸部肿瘤科收治的小细胞肺癌脑转移患者108例为研究对象,按照平均原则随机分成两组即实验组和对照组各54例,均采用了替莫唑胺治疗和脑部放疗,其中,对照组放疗同步联合应用替莫唑胺,而实验组采用放疗前后序贯应用替莫唑胺,联合应用后患者均继续采用了替莫唑胺维持治疗,对比分析了2组患者的肿瘤显效率、生存情况及不良反应发生情况,并进行统计学分析。结果放疗前后实验组白细胞减少发生(8×10~9),明显低于对照组(131×10~9),差异有统计学意义(P<0.05),实验组放疗前后序贯应用替莫唑胺治疗后患者显效率是69.57%及总治疗显效率是99.08%,对照组放疗同步联合应用替莫唑胺治疗后患者显效率是50.46%总治疗显效率是85.64%,而实验组眩晕、恶心、呼吸困难消失的时间比对照组快,实验组放疗前后序贯应用替莫唑胺治疗后患者显效率比对照组放疗同步联合应用替莫唑胺治疗后患者显效率高,而实验组眩晕、恶心、呼吸困难消失的时间比对照组快,实验组与对照组两组治疗后比较均差异有统计学意义(P<0.05),放疗前后实验组3个月生存率与对照组之间差异无统计学意义(P>0.05),放疗前后实验组6个月生存率(65.64%)明显高于对照组(49.08%),两组之间差异有统计学意义(P<0.05)。结论对小细胞肺癌脑转移患者采取放疗前后序贯应用替莫唑胺治疗能够有效提高患者生存率,同步减少患者白细胞减少的发生率,减小并发症的发生率,提高治愈率,尤其是联合治疗起效快,治疗效果好,值得临床推广。

Objective To investigate the clinical analysis of radiotherapy combined with temozolomide in the treatment of patients with small cell lung cancer with brain metastasis. Methods 108 patients with small cell lung cancer brain metastases admitted to the Department of Thoracic Ontology in January 2015 to August 2016. Subjects were randomly divided into two groups according to the average principle, namely, 54 patients in the experimental group and the con- trol group. Temozolomide treatment and brain radiotherapy were used. The control group was treated with temozolomide in combination with radiotherapy, and the experimental group was treated with temozolomide before and after radio- therapy. After combined application, patients continued to use temozolomide maintenance therapy. The tumors showed significant efficiency, survival and adverse reactions in two groups, and statistical analysis was performed. Results The leukopenia of the experimental group before and after radiotherapy occurred （8×109）, significantly lower than the control group （131×109）, the difference was statistically significant （P〈0.05）, the experimental group was treated with temozolo-mide before and after radiotherapy, the effective rate was 69.57% and the total treatment efficiency was 99.08%, the control group effective rate of radiotherapy combined with temozolomide treatment was 50.46%. The effective rate of treatment was 85.64%, and the time of vertigo, nausea, and dyspnea disappeared in the experimental group was faster than that in the control group. The effective rate of the patients in the experimental group was significantly higher than that in the control group after the combination of temozolomide and radiotherapy, while the experimental group vertigo, nausea, dyspnea disappeared faster than the control group, the experimental group and the control group were statisti- cally different after treatment （P〈0.05）, the experimental group before and after the radiotherapy for 3 months and the control group had no significant difference for the rate （P〉0.05）. The 6-month survival rate of the experimental group before and after radiotherapy （65.64%） was significantly higher than that of the control group （49.08%）. The difference between the two groups was statistically significant （P〈0.05）. Conclusion The sequential application of temozolomide in patients with small cell lung cancer with brain metastases can effectively improve the survival rate of patients, reduce the incidence of leukopenia, reduce the incidence of complications, and improve the cure rate, especially in combina- tion therapy. The effect is fast, the treatment effect is good, and it is worthy of clinical promotion.