立体定向放射外科联合酪氨酸激酶抑制剂治疗EGFR突变肺腺癌脑转移的剂量探讨

Appropriate dose of stereotatic radiosurgery(SRS)for treatment of brain metastasis in patients with lung adenocarcinoma undergoing tyrosine kinase inhibitor(TKI)therapy

目的探讨伽玛刀立体定向放射外科(SRS)联合酪氨酸激酶抑制剂(TKI)治疗表皮生长因子受体(EGFR)突变肺腺癌脑转移的合适剂量。方法选取武警海警总队医院2012至2018年采用SRS联合TKI治疗的EGFR突变肺腺癌脑转移患者52例,按SRS处方剂量分为低剂量(16 Gy)组和标准剂量(18~22 Gy)组,每组26例。比较两组患者的客观反应率(ORR),1、2年野内局控率及放射性脑坏死发生率。结果低剂量组、标准剂量组ORR分别为91.7%、81.8%,差异无统计学意义(P>0.05)。低剂量组、标准剂量组1年野内局控率均为100.0%;2年野内局控率分别为92.3%、96.2%,差异无统计学意义(P>0.05)。低剂量组、标准剂量组放射性脑坏死发生率分别为3.8%、23.1%,差异有统计学意义(P<0.05)。结论SRS联合TKI治疗EGFR突变肺腺癌脑转移的剂量降至16 Gy可减少放射性脑坏死,且不影响疗效。

Objective To derm the appropriate dose of stereotatic radiosurgery(SRS)for brain metastasis in lung adenocarcinoma patients with epidermal growth factor receptor(EGFR)mutation undergoing tyrosine kinase inhibitor(TKI)therapy.Methods From 2012 to 2018,52 patients with brain metastases of EGFR mutation lung adenocarcinoma treated with SRS combined with TKI were enrolled and divided into low-dose(16 Gy)group and standard dose(18-22 Gy)group according to the prescription dose of SRS,with 26 cases in each group.The overall response rate(ORR),in-field local control rate and radiation brain injury rate in two groups were analyzed.Results The ORR of low dose group and standard dose group were 91.7%and 81.8%,respectively(P>0.05).The in-field local control rate was 100.0%in both groups in the first year,and was 92.3%and 96.2%in the second year(P>0.05).The incidence of radiation-induced brain necrosis was 3.8%in the low-dose group and 23.1%in the standard dose group(P<0.05).Conclusion When lung adenocarcinoma patients with EGFR mutation receive SRS combined with TKI for treatment of brain metastasis,the low dose of SRS(16 Gy)does not affect the efficacy,but it can the radiation brain injury compared with the standard dose.