替莫唑胺联合全脑放疗治疗乳腺癌脑转移的临床观察

目的探讨替莫唑胺联合全脑放疗治疗乳腺癌脑转移的疗效和安全性。方法 2007年6月至2010年10月我科共治疗21例乳腺癌脑转移患者。给药方法：替莫唑胺75mg/m2,口服,从放疗第一天开始至结束。放疗结束后,替莫唑胺150mg/m2,d1～d5,连服5天,28天重复,连服2周期。放疗采用全脑照射（whole brain radiotherapy,WBRT）,DT40GY/20f/4W;部分患者加用γ刀治疗,DT18GY。结果全组总有效率为76.2%（CR＋PR）,其中CR3例（14.3%）,PR13例（61.9%）。中位生存期为11.2个月,中位缓解期为9个月。血液毒性主要为Ⅰ～Ⅱ度白细胞下降（71.4%）。非血液毒性主要为胃肠道反应。结论替莫唑胺联合全脑放疗治疗乳腺癌脑转移是有效安全的,可一定程度延长生存时间。

Clinical Observation of Temozolomide Combined with Whole Brain Irradiation for Brain Metastases of Breast Carcinoma

Objective To investigate the prognosis and safety of temozolomide combined with whole brain irradiation in treatment of brain metastases of breast carcinoma. Methods 21 patients with brain metastases of breast cancer in our hospital from June 2007 to October 2010 were treated with temozolomide and whole brain irradiation. Temozolomide medication： 75 mg/m2 temozolomide by oral, qid during radiotherapy; 150 mg/m2 temozolomide from the first day to the fifth day after radiotherapy, repeating 28 days for continuous 2 cycles. The radiotherapy used whole brain irradiation; the prescribed dose was 40 Gy/20 F/4 W. Some patients added with γ knife therapy and the prescribed dose was 18 Gy. Results The clinical response rate was 76.2% （CR ＋ PR）, including 3 cases of CR （14.3%） and 13 cases of PR （61.9%）. The median survival was 11.2 months, while the median remission was 9 months. The main blood toxicity was Ⅰ ~ Ⅱ degrees of leucopenia, and the other main side effects were gastrointestinal reaction. Conclusions The combination of temozolomide and whole brain irradiation is effective and safe in treatment of brain metastasesof breast carcinoma, which can improve the survival in a certain extent.