摘要
背景与目的:放射治疗是治疗脑转移癌的主要手段,而到目前为止化疗与放疗联合治疗脑转移癌的研究较少。本研究旨在观察COAPC方案化疗与脑部放射同时治疗非小细胞肺癌(non-smallcelllungcancer,NSCLC)脑转移患者的疗效、不良反应及生存率。方法:45例NSCLC脑转移患者接受COAPC方案化疗,环磷酰胺0.3g/m2第1天静推,长春新碱1.4mg/m2第1天静推,阿霉素50mg/m2第1天静推,顺铂20mg/m2第1~5天静滴,司莫司汀80mg/m2第1天口服,每3~4周为1疗程。脑部放射治疗于化疗第1疗程的第6天开始,每次2Gy,每天1次,每周5天。脑转移灶1~3个者,全脑放疗40Gy后,缩野放疗至总量60Gy;脑转移灶>3个者,全脑放疗至总量40Gy。结果:治疗后80%患者神经系统症状改善,对脑转移灶的客观有效率为64.4%,对肺原发灶的有效率为40%。治疗的主要不良反应为骨髓抑制(Ⅲ~Ⅳ度占35%)。中位生存期10个月,1年生存率44.1%,5年生存率6.7%。单纯脑转移患者的中位生存期14个月,高于多发远处转移患者的9个月(P=0.012)。结论:化疗联合脑部放射治疗NSCLC脑转移患者有效率与生存率较高,且患者耐受性较好。
BACKGROUND &OBJECTIVE: The main treatment strategy of cancer patients with brain metastases was irradiation; while so far there were few researches concerning chemotherapy combined with radiotherapy for these patients. This study was designed to observe the therapeutic effect, toxicity, and survival of concurrent whole brain radiotherapy (WBRT) combined chemotherapy with COAPC regimen in non small cell lung cancer (NSCLC) patients with brain metastases. METHODS: A total of 45 NSCLC patients with brain metastasis received a course of COAPC regimen [cyclophosphamide 0 3 mg/m2 iv d1, vincristine 1 4 mg/m2 iv d1, doxorubicin 50 mg/m2 iv d1, cisplatin 20 mg/m2 iv d1-5,semustine 80 mg/m2 PO d1] every 3-4 weeks.Whole brain radiotherapy was administered on day 6 of the first course of chemotherapy using 60Co at a dose of 2 Gy given in 5 fractions per week. Patients with brain lesions of 1-3 received WBRT at a dose of 40 Gy and then small field to a total dose of 60 Gy. Patients with brain lesions of more than 3 received WBRT at a total dose of 40 Gy. RESULTS: The treatment improved neurological symptoms in 80%〓of the patients. The response rates to brain lesions and primary lesions were 64 4%〓and 40 0%, respectively. The median survival time (MST) was 10 months. The 1 year and 5 year survival rates were 44 1%and 6 7%, respectively.The MST in the patients with brain metastasis was only 14 months,which was longer than the MST of 9 months in the patients with other metastasis sites(P=0 012). CONCLUSION: Concurrent WBRT and chemotherapy can be safely preformed for the patients with brain metastasis from NSCLC with a remarkable response rate and encouraging survival duration.
出处
《癌症》
SCIE
CAS
CSCD
北大核心
2003年第4期407-410,共4页
Chinese Journal of Cancer
关键词
脑转移癌
放射疗法
非小细胞肺癌
药物疗法
Brain metastasis/radiotherapy
Brain metastasis/chemotherapy
Non small cell lung cancer/chemotherapy