放疗联合替莫唑胺治疗肺癌脑转移瘤的疗效观察

Clinical efficacy of the radiotherapy combined with temozolomide for brain metastases in lung cancer

目的探讨放疗联合替莫唑胺治疗肺癌脑转移瘤的临床疗效和不良反应。方法选取2012年5月至2016年6月间山东省济南市中西医结合医院收治的63例肺癌脑转移患者,采用随机数表法分为治疗组(32例)和对照组(31例)。治疗组患者采用放疗加口服替莫唑胺治疗,对照组患者采用单纯放疗治疗,比较两组患者的临床疗效和不良反应。结果两组患者脑部主要症状改善率比较,放疗剂量30Gy时,治疗组患者有效率为84. 4%(27例),对照组为61. 3%(19例),差异有统计学意义(P <0. 05)。治疗结束时,治疗组患者主要脑部症状总改善率为96. 9%(31例),对照组为77. 4%(24例),差异有统计学意义(P <0. 05)。两组患者治疗后脑转移灶直径变化情况中各项治疗效果比较,差异均无统计学意义(均P> 0. 05)。治疗后,治疗组患者生活质量评分提高率为90. 6%(29例),对照组为64. 5%(20例),差异有统计学意义(P <0. 05)。治疗组患者主要不良反应为血液毒性反应,Ⅱ~Ⅲ级骨髓抑制率为43. 8%(14例);消化道反应率为40. 6%(13例),主要为恶心、呕吐等,但均为Ⅰ~Ⅱ级。治疗后1年,治疗组患者生存率为62. 5%(20例),对照组为35. 5%(11例),差异有统计学意义(P <0. 05)。治疗组患者1年生存率与脑转移灶多少和有无颅外转移等有一定关系,单发脑转移患者的1、2年生存率明显高于多发患者,差异有统计学意义(P <0. 05)。结论放疗联合替莫唑胺治疗肺癌脑转移瘤患者症状改善快且明显,有较好的近期疗效,不良反应可耐受。

Objective Analyze the curative efficacy and adverse reactions of the radiotherapy combined with temozolomide(TMZ)in treating brain metastatic tumors in patients with lung cancer.Methods A total of 63 patients with brain metastatic tumors complicated with lung cancer treated at Jinan Hospital of Integrated Traditional Chinese and Western Medicine from May 2012 to June 2016 were selected and divided into a treatment group and a control group with 32 patients in each group.The treatment group was given radiotherapy combined with oral TMZ and the control group was only given radiotherapy.Clinical efficacy and adverse reactions were compared between the two groups.Results The main clinical symptom improvement was as following:the efficacy was 84.4%(27 patients)for the treatment group and 61.3%(19 patients)for the control group when the treatment dose was 30 Gy(P<0.05).The main clinical symptom improvement rate was 96.9%(31 patients)in the treatment group and 77.4%(24 patients)in the control group at the end of the treatment(P<0.05).The main adverse reactions included blood toxicity.GradeⅡtoⅢmyelosuppression rate was 43.8%(14 patients).The reaction rate for digestive tract was40.6%(13 patients)which mainly included gradeⅠtoⅡnausea and vomiting.The 1-year survival rate was 62.5%(20 patients)in the treatment group and 35.5%(11 patients)in the control group respectively(P<0.05).The 1-year survival rate was associated with brain metastatic tumors and extracranial metastases.The 1-and 2-year survival rate was higher in patients with single brain metastasis than patients with multiple brain metastasis(P<0.05).Conclusion Radiotherapy combined with TMZ for the brain metastatic tumor has a good efficacy.Patients have good short-term efficacy.The adverse reactions are tolerable.