替莫唑胺与放疗对肺癌脑转移临床治疗效果、免疫功能改善及并发症发生情况的影响

Clinical Efficacy of Temozolomide and Radiotherapy for Brain Metastases of Lung Cancer,Improvement of Immune Function and Complication

目的研究替莫唑胺与放疗对肺癌脑转移临床治疗效果、免疫功能改善及并发症发生情况的影响。方法选取肺癌脑转移患者84例,按照奇偶法,将纳入患者分为观察组和对照组(每组42例)。观察组采用口服替莫唑胺联合放疗、对照组单纯采用放疗,连续6个疗程。观察和记录两组患者治疗前后肿瘤病灶大小、免疫功能(T淋巴细胞亚群数量)和治疗期间并发症及生存时间、生存质量。结果观察组患者完全缓解率(21.43%)、部分缓解率(71.43%)、临床受益率(97.62%)、有效率(92.86%)均高于对照组完全缓解率(7.14%)、部分缓解率(47.62%)、临床受益率(83.33%)、有效率(54.76%),差异有统计学意义(P<0.05)。观察组患者6个月、1年、2年生存率(83.33%、61.90%、7.14%)均高于对照组的(71.43%、42.86%、2.38%),差异有统计学意义(P<0.05)。生存质量升高率(90.48%)高于对照组的(52.38%)、稳定率(7.14%)和下降率(2.38%)低于对照组的(30.95%、16.67%),差异均有统计学意义(P<0.05)。治疗后与治疗前CD3^+、CD4^+、CD8^+细胞绝对计数差值,观察组CD3^+、CD4^+下降水平(-47.45±108.13)cells/μl、(-49.19±116.85)cells/μl,低于对照组的(-132.61±165.10)cells/μl、(-108.10±171.94)cells/μl,CD8^+上升水平(-1.10±75.88)cells/μl低于对照组的(42.55±79.28)cells/μl,差异均有统计学意义(P<0.05)。观察组患者并发症中Ⅰ度、Ⅱ度、Ⅲ度构成比分别为23.81%、61.90%、14.29%,均高于对照组的19.05%、69.05%、11.90%,但差异均无统计学意义(P>0.05)。结论口服替莫唑胺结合放疗干预肺癌脑转移效果显著、安全可靠,且能明显阻断患者免疫功能下降水平,利于提高患者生存质量、耐受度、降低并发症严重程度,优于单纯放疗,是一种行之有效的治疗手段,值得推广。

Objective To study the effect of temozolomide and radiotherapy on clinical treatment effect of lung cancer brain metastasis,immune function improvement and complications.Methods 84 patients with brain metastases of lung cancer were selected.Patients were divided into observation group and control group(42 cases in each group)according to parity method.The observation group was treated with oral temozolomide combined with radiotherapy and the control group with radiotherapy alone for 6 consecutive courses.The size of tumor focus,the immune function(the number of T lymphocyte subsets)and the complication,survival time and quality of life before and after treatment were observed and recorded in both groups.Results The complete remission rate was 21.43%in the observation group,the partial remission rate was 71.43%,the clinical benefit rate was 97.62%,the effective rate was 92.86%,which were all higher than the control group,the difference was statistically significant(P<0.05).The 6-month,1-year and 2-year survival rates in the observation group were 83.33%,61.90%and 7.14%,respectively,which were significantly higher than 71.43%,42.86%and 2.38%in the control group(P<0.05).The rate of increase of the quality of life was 90.48%higher than that of the control group(52.38%),the stability rate was 7.14%and the rate of decline was 2.38%,which was lower than that of the control group(30.95%,16.67%,P<0.05).The difference between the absolute counts of CD3^+,CD4^+,CD8^+cells before treatment and after treatment was statistically significant.The levels of CD3^+and CD4^+decreased(-47.45±108.13)cells/μl and(-49.19±116.85)cells/ul,the level of CD8^+increase(-1.10±75.88)cells/μl was lower than that of the control group(42.55±79.28)cells/ul,the differences were statistically significant(P<0.05).TheⅠ,Ⅱ,andⅢdegrees of complication in the observation group were 23.81%,61.90%and 14.29%higher than those in the control group(19.05%,69.05%and 11.90%,respectively),but the differences were not statistically significant(P>0.05).Conclusion Oral temozolomide combined with radiotherapy has significant effect on brain metastasis of lung cancer,which is safe and reliable.It can obviously block the decline of immune function,improve the patients'quality of life and tolerance and reduce the severity of complications.It is better than radiotherapy alone Effective treatment,it is worth promoting.