替莫唑胺联合全脑同期局部推量调强放疗治疗肺癌脑转移的效果及安全性分析

Efficacy and safety of temozolomide combined with whole brain simultaneous local push intensity modulated radiotherapy in the treatment of brain metastasis of lung cancer

目的:探讨替莫唑胺联合全脑同期局部推量调强放疗治疗肺癌脑转移的效果及安全性。方法:收集2019年1月至2021年6月宜春市人民医院收治的肺癌脑转移患者60例,按照随机数字表法分为对照组和研究组各30例。对照组采用全脑+同期局部推量调强放疗,计划肿瘤靶体积处方剂量为50 Gy/2.5 Gy/20 F,同时,计划临床靶体积处方剂量为40 Gy/2 Gy/20 F,每日1次,1周5次,共4周。研究组采用全脑+同期局部推量调强放疗(方法同对照组),患者同步每天口服替莫唑胺胶囊75 mg/m2,放疗结束后停服。比较两组治疗后3个月的近期疗效、治疗前后卡氏评分(KPS)变化、无进展生存时间(PFS)、总生存时间(OS)以及不良反应发生情况的差异。结果:研究组客观缓解率(ORR)高于对照组(P<0.05)。研究组治疗后KPS评分高于对照组(P<0.05),PFS、OS均长于对照组(P<0.05)。两组中性粒细胞减少、血小板减少、贫血、恶心/呕吐、头痛、认知功能障碍等不良反应发生率差异无统计学意义(P>0.05)。结论:替莫唑胺联合全脑同期局部推量调强放疗治疗肺癌脑转移疗效显著且安全性良好,值得临床推荐。

Objective:To investigate the efficacy and safety of temozolomide combined with whole brain simultaneous local push intensity modulated radiotherapy in the treatment of brain metastasis of lung cancer.Methods:Sixty patients with brain metastasis of lung cancer from January 2019 to June 2021 were included in Yichun People’s Hospital,and according to the random number table method divided into a control group and a research group with 30 cases in each group.The control group was treated with whole brain simultaneous local push intensity modulated radiotherapy,the prescribed dose of the planned tumor target volume was 50 Gy/2.5 Gy/20 F,and at the same time,the planned clinical target volume prescription dose was 40 Gy/2Gy/20 F,once a day,five times a week,for four weeks.The research group was treated with whole brain simultaneous local push intensity modulated radiotherapy,and the patients took temozolomide capsule 75 mg/m2 orally every day and stopped taking it after radiotherapy.The short-term efficacy,changes of Karnofsky score(KPS),progression free survival time(PFS),overall survival time(OS)and adverse reactions were compared between the two groups 3 months after treatment.Results:The objective remission rate(ORR)in the research group was higher than that in the control group(P<0.05);the KPS score in the research group was higher than that in the control group after treatment(P<0.05);PFS and OS in the research group were longer than those in the control group(P<0.05);there were no significant differences in the incidence of neutropenia,thrombocytopenia,anemia,nausea/vomiting,headache,cognitive impairment and other adverse reactions between the two groups(P>0.05).Conclusion:Temozolomide combined with whole brain simultaneous local push intensity modulated radiotherapy is effective and safe in the treatment of brain metastasis of lung cancer,which is worthy of clinical recommendation.