埃克替尼联合放疗治疗EGFR突变型肺腺癌无症状脑转移疗效观察

目的 评价埃克替尼联合放疗在治疗EGFR突变型肺腺癌无症状脑转移患者中的作用.方法 回顾性分析2012年1月至2015年6月广西医科大学第三附属医院61例EGFR突变型肺腺癌无症状脑转移患者的临床资料,其中埃克替尼联合放疗(联合组)23例,埃克替尼单药治疗(靶向治疗组)38例.靶向治疗第1、3、5个月及之后每3个月复查评价疗效.χ2检验评价两组客观缓解率、疾病控制率,Kaplan Meier法和Log-rank法进行生存分析.结果 在靶向治疗第5个月,联合组的总客观缓解率和总疾病控制率分别为82.6%和95.7%,均明显高于靶向治疗组的55.3%和76.3%,差异均有统计学意义(P<0.05);联合组的脑转移瘤客观缓解率和疾病控制率分别为95.7%和100.0%,均明显高于靶向治疗组的55.3%和81.6%,差异均有统计学意义(P<0.05);中位无进展生存时间联合组14个月,靶向治疗组8个月,差异亦有统计学意义(P<0.05);Ⅲ~Ⅳ级毒副反应中,联合组疲乏、恶心、呕吐明显高于靶向治疗组,差异均有统计学意义(P<0.05),但可耐受,皮疹、腹泻、骨髓抑制差异均无统计学意义(P>0.05).结论 埃克替尼联合放疗明显提高EGFR突变型肺腺癌无症状脑转移患者的治疗效果,延长患者中位无进展生存时间,毒副反应可以耐受.

Clinical effect of icotinib combined with radiotherapy for asymptomatic brain metastasis in patients with epidermal growth factor receptor mutant non-small cell lung cancer

Objective To assess the efficacy of icotinib combined with radiotherapy for asymptomatic brain metastasis (BM) in patients with epidermal growth factor receptor (EGFR) mutant non-small cell lung cancer (NSCLC). Methods Sixty-one patients diagnosed as EGFR mutant NSCLC with asymptomatic BM treated in the Third Affiliated Hospital of Guangxi Medical University from January 2012 to June 2015 were retrospectively reviewed. Twenty-three of them were treated with icotinib and brain radiotherapy (joint therapy group). Thirty-eight of them were treated with Ico-tinib only (targeting treatment group). The curative effect in target therapy after 1, 3, 5 months and every 3 months (in-cluding cranial MRI examination), and at the end of radiotherapy were evaluated.χ2 test between two groups was carried out to evaluate the objective response rate (ORR), disease control rate (DCR), and the Kaplan Meier method and the Log-rank method were used for survival analysis. Results In the fifth month of targeted therapy, the overall ORR and DCR in the joint therapy group were 82.6%and 95.7%, which in the targeting treatment group were 55.3%and 76.3%, showing the differences were statistically significant (P<0.05). The levels of ORR and DCR about brain metastasis in the joint therapy group were 95.7%and 100.0%, which were significantly higher than those in the targeting treatment group (55.3%and 81.6%), showing the differences were statistically significant (P<0.05). The median progression-free survival time in the joint therapy group was 14 months, but which in the targeting therapy group was 8 months, showing the differences were statistically significant (P<0.05). Regarding theⅢ~Ⅳdegree of toxicity, the incidence of fatigue, nausea and vomiting in the joint therapy group were significantly higher than those in the targeting treatment group, which could be tolerated (P<0.05). But no difference existed in the occurrence of erythra, diarrhea and myelosuppres-sion (P>0.05). Conclusion Icotinib combined with radiotherapy could obviously improve the outcome and the median progression-free survival time of the asymptomatic BM in patients with EGFR mutant NSCLC, and side effects are tol-erable.