盐酸埃克替尼联合调强放疗对表皮生长因子受体突变阳性肺腺癌脑转移的有效性及安全性分析

Efficacy and safety analysis of icotinib hydrochloride combined with intensity modulated radiation therapy in the treatment of brain metastases from epidermal growth factor receptor mutation-positive lung adenocarcinoma

目的 分析盐酸埃克替尼联合调强放疗(intensity modulated radiation therapy,IMRT)治疗表皮生长因子受体(epidermal growth factor receptor,EGFR)突变阳性肺腺癌脑转移的有效性及安全性。方法 回顾性分析河南大学第一附属医院2017年4月至2019年4月收治的100例EGFR突变阳性肺腺癌脑转移患者的临床资料,并按治疗方式分为靶向治疗组(n=50)及联合组(n=50)。靶向治疗组接受盐酸埃克替尼治疗,联合组在靶向治疗组基础上接受IMRT治疗。靶向治疗4个月后判定两组近期疗效,统计两组不良反应发生情况,检测两组入组时及靶向治疗4个月后血清肿瘤标志物(癌胚抗原、糖类抗原19-9及细胞角质蛋白19片段抗原21-1)水平,并随访观察2年生存情况。结果 联合组客观缓解率82.00%,高于靶向治疗组的58.00%(P <0.05)。两组皮疹、恶心呕吐、乏力、骨髓抑制、腹泻及肝肾损伤等不良反应均在Ⅰ~Ⅲ度,患者均可耐受,两组不良反应分级比较,差异无统计学意义(P> 0.05)。靶向治疗4个月后,两组血清肿瘤标志物水平较入组时降低(P <0.05),且联合组较靶向治疗组低(P <0.05)。联合组2年生存率38.00%,高于靶向治疗组的20.00%(P <0.05)。结论 对EGFR突变阳性肺腺癌脑转移患者实施盐酸埃克替尼联合IMRT治疗,可获得较好的近、远期效果,且不良反应较轻,患者可耐受。

Objective To analyze the efficacy and safety of icotinib hydrochloride combined with intensity-modulated radiation therapy(IMRT) in the treatment of brain metastases from epidermal growth factor receptor(EGFR) mutation-positive lung adenocarcinoma.Methods One-hundred cases of brain metastases patients from EGFR mutation-positive lung adenocarcinoma admitted to the first affiliated hospital of Henan university from April 2017 to April 2019 were retrospectively analyzed,and they were divided into the targeted therapy group(n=50) and the combined therapy group(n=50) according to the treatment method.The targeted therapy group were treated with icotinib hydrochloride,and the combined therapy group received IMRT treatment on the basis of the targeted therapy group.After four months of targeted therapy,the short-term curative effects of the two groups were evaluated,the occurrence of adverse reactions in the two groups were counted,the levels of serum tumor markers(carcinoembryonic antigen,carbohydrate antigen 19-9,and cytokeratin 19 fragment antigen 21-1) were detected at the time of enrollment and four months after targeted therapy,and the two-year survival rate was followed up.Results The objective remission rate in the combined therapy group was 82.00%,which was significantly higher than 58.00% in the targeted therapy group(P<0.05).The adverse reactions such as rash,nausea and vomiting,fatigue,bone marrow suppression,diarrhea,liver and kidney injury in the two groups were all in the grade Ⅰ to Ⅲ,which were tolerated by the patients.There was no significant difference in the grade of adverse reactions between the two groups(P>0.05).After four months of targeted therapy,the levels of serum tumor markers in the two groups were significantly lower than those in the same group when joining the group(P<0.05),and the combined therapy group were significantly lower than those in the targeted therapy group in the same period(P<0.05).The two-year survival rate of the combined therapy group was 38.00%,which was significantly higher than that in the targeted therapy group(20.00%)(P<0.05).Conclusion Icotinib hydrochloride combined with IMRT in the treatment of brain metastasis from EGFR mutation-positive lung adenocarcinoma can achieve better short-term and long-term effects,and the adverse reactions are mild and can tolerated by the patients.