拓扑替康联合顺铂治疗肺癌脑转移28例临床观察

目的:观察拓扑替康(TPT)联合顺铂(PDD)治疗肺癌脑转移的疗效与毒性。方法:28例患者分别接受5天用药或每周用药方案化疗2~6周期。16例患者接受TPT1·2mg/m2,第1~5天;12例患者接受TPT2·5mg/m2,第1、8、15天;均联合PDD25mg/m2,第1~3天,28天为1周期。按WHO标准评价疗效及不良反应。结果:28例中无完全缓解,部分缓解(PR)11例(39·3%),稳定(SD)10例(35·7%)和进展(PD)7例(25·0%)。中位疾病进展时间为5·2个月,中位生存时间为8·7个月。结论:TPT联合PDD治疗肺癌脑转移患者效果肯定,毒副反应能够耐受,值得进一步推广使用并深入探讨。     

甲磺酸奥希替尼治疗EGFR基因突变型非小细胞肺癌脑转移的疗效评价

目的:探讨甲磺酸奥希替尼治疗表皮生长因子受体(epidermal growth factor receptor,EGFR)基因突变型非小细胞肺癌(non-small-cell lung cancer,NSCLC)脑转移的临床效果及预后因素.方法:回顾分析2017年5月-2019年12月60 例由蚌埠医学院第一附属医院肿...     

EGF receptor tyrosine kinase inhibitors in the treatment of brain metastases from non-small-cell lung cancer

The incidence of brain metastasis (BM) is high in patients with non-small-cell lung cancer. Available standard therapeutic options, such as whole-brain radiation therapy and systemic chemotherapy, provide a slight improvement in local control, overall survival and symptom relief. Novel agents, such as EGF receptor (EGFR) tyrosine kinase inhibitors (TKIs), have now been included in standard non-small-cell lung cancer treatments. In a small subset of patients harboring EGFR-activating mutations, erlotinib and gefitinib administration was followed by a response rate of 70–80%, and a longer progression-free and overall survival than those obtained with standard chemotherapeutic regimens. However, since most of the larger studies on these agents have excluded BM patients from their series, few prospective data are available on the efficacy of these agents in this setting. In recent years, however, several authors have reported a growing number of cases of partial and complete response in BM patients treated with EGFR TKIs. Data from retrospective series and Phase II studies also suggest that a response can be obtained using EGFR TKI treatment for patients with BM, especially those harboring EGFR mutations.     

非小细胞肺癌脑转移综合治疗的疗效分析

目的:探讨非小细胞肺癌(NSCLC)脑转移不同治疗方法的疗效分析及预后因素.方法:回顾性分析2001-01-2006-06我科治疗的71例NSCLC脑转移患者,14例行手术+放疗±化疗,26例行单纯放疗,31例行放疗+化疗.42例行全脑放疗土局部加量,29例行全脑放疗+三维适形调强放疗.全部病例定期随访直至死亡,分别行单因素和多因素分析.结果:全组中位生存期为10个月,1、2和3年生存率分别为29.58%(21/71)、16.90%(12/71)和8.45%(6/71).单因素分析显示,KPS评分、病理类型、脑转移数目、脑转移大小、原发灶控制、中枢外转移、治疗方法、放疗剂量、放疗方式和近期疗效对生存期有影响.多因素分析显示,KPS评分、脑转移数目、原发灶控制、中枢外转移和近期疗效是独立的生存预后因素.结论:NSCLC脑转移的主要预后因素是KPS评分、脑转移数目、原发灶控制、中枢外转移、近期疗效.积极治疗可适当延长生存期.     

非小细胞肺癌脑转移治疗的研究进展

肺癌是全球范围内发病率和死亡率最高的恶性肿瘤,非小细胞肺癌（non-small cell lung cancer,NSCLC）约占肺癌的80%,其中超过40%的晚期NSCLC患者在疾病病程中会发生脑转移,导致预后不良。传统的治疗方法如单纯放疗,化疗,外科手术对于改善肺癌脑转移的预后非常有限。近些年来随着立体定向放射治疗、靶向治疗的发展,尤其是化疗联合靶向,放疗联合靶向等交叉领域的联合治疗,NSCLC脑转移患者的生存质量得到提高,中位总生存期（median overall survival,mOS）得以延长。然而对于NSCLC脑转移的最佳治疗方案,仍然存在争议,本文将针对NSCLC脑转移领域的最新研究进展进行阐述,以期对肺癌脑转移患者选择合理治疗方案提供理论依据。      

非小细胞肺癌伴单发脑转移瘤的外科治疗

目的 探讨非小细胞肺癌伴单发脑转移瘤的外科治疗及预后.方法 回顾我院1991年1月至2002年1月收治的56例非小细胞肺癌伴单发脑转移瘤患者临床资料,脑转移瘤伽马刀治疗后均行肺癌根治术,术后常规化疗和全脑放疗,并评估疗效.结果 本组患者均无严重手术并发症,1年生存率为73.5%(36/49),3年34.7%(17/49),5年16.3%(8/49),中位生存期20.5个月.结论 非小细胞肺癌伴单发脑转移瘤外科治疗可以延长患者的生存期和提高治疗效果.     

Treatment of brain metastases from lung cancer: chemotherapy

Brain metastases are a frequent complication in patients suffering from Lung cancer, and a significant cause of morbidity and mortality. Brain metastases are found in about 10% of patients at the time of diagnosis, and approximately 40% of all patients with lung cancer develop brain metastases during the course of their disease. The prognosis of these patients is rather poor. The standard treatment for brain metastases, so far, has been whole-brain radiation therapy and surgery focussing on symptom palliation. The use of chemotherapy for the treatment of brain metastases has been limited because of a presumed lack of effectiveness due to the blood-brain barrier. However, the importance of the blood-brain barrier is probably overrated in the case of macroscopic metastases or relapsed disease as the blood-brain barrier has already been disrupted at this stage resulting from the newly developed blood vessels not provided with the physiological properties of the common blood-brain barrier. Chemotherapeutic agents initially lipid-insoluble or liquor-impermeable can also penetrate into the brain and, therefore, trigger action against tumour cells. A number of clinical trials have demonstrated that brain metastases resulting from both small-cell lung cancer and non-small-cell lung cancer are susceptible to systemic chemotherapy. In small-cell lung cancer, cerebral response rates up to 50% were observed even in the second-line situation and were comparable to the response rates observed in the primary tumour. In non-small-cell lung cancer, similar results were achieved. Therefore, it seems justified to further evaluate the significance of chemotherapy compared to whole-brain radiation therapy. Whether chemotherapy alone is superior to whole-brain radiation therapy, or whether the combination of both therapeutic modalities should be preferred for the management of brain metastases, has not yet been proven, and further randomised phase-III studies are clearly needed. Based on the current available data, and the promising response rates in patients with lung cancer, chemotherapy should be considered for the management of brain metastases as part of a multimodality (or "interdisciplinary") treatment concept.     

化疗在肺癌脑转移中的应用

肺癌患者脑转移发生率高，预后差，适合手术或立体放射外科治疗的比率低，单药化疗和联合化疗对脑转移灶能达到与原发灶相近的有效率，全脑放疗(WBRT)合并同时化疗可能提高肺癌脑转移患者的治疗效果。     

Pronostic factors of synchronous brain metastases from lung cancer

BACKGROUND: The prognosis of brain metastases (BM) from lung cancer is poor. The management of lung cancer with BM is not clear. This retrospective study attempts to determine their prognostic factors, and to better define the role of different treatments. METHODS: We reviewed the clinical characteristics of 271 consecutive patients with synchronous brain metastases (SBM) from lung cancer (small-cell lung cancers and non-small-cell lung cancers), collected between January 1985 and May 1993. Data were available for all patients as well as follow-up information on all patients through to death. Patients had all undergone heterogeneous treatments. Each physician had chosen the appropriate treatment after collegiate discussion. Survival curves were compared using the log-rank test in univariate analysis, and Cox's Regression model in multivariate analysis. Statistical significance was defined as P<0.05. RESULTS: 249 patients were assessable. Treatments included: neurosurgical resection in 56 cases, brain irradiation in 87 cases, and chemotherapy in 126 cases. Median overall survival time from the date of histological diagnosis of SBM was 103 days (range, 1-1699). In multivariate analysis, prognostic factors for longer overall survival times were: absence of adrenal metastases (P=0.007), neurosurgical resection (P=0.028), chemotherapy (P=0.032) and brain irradiation (P=0.008). Moreover, risk factors of intracranial hypertension as cause of death were number of SBM and absence of neurosurgical resection. CONCLUSIONS: These results and others suggest that patients with SBM from lung cancer be considered for carcinologic treatment, and not only for best supportive care. However, further studies are necessary to evaluate quality of life with or without carcinologic treatment.     

Attributes of brain metastases from breast and lung cancer

Background

Most brain metastases arise from breast and lung cancers. Few studies compare the brain regions they involve, their numbers and intrinsic attributes.

Methods

Records of all patients referred to Radiation Oncology for treatment of symptomatic brain metastases were obtained. Computed tomography (n = 56) or magnetic resonance imaging (n = 72) brain scans were reviewed.

Results

Data from 68 breast and 62 lung cancer patients were compared. Brain metastases presented earlier in the course of the lung than of the breast cancer patients (p = 0.001). There were more metastases in the cerebral hemispheres of the breast than of the lung cancer patients (p = 0.014). More breast than lung cancer patients had cerebellar metastases (p = 0.001). The number of cerebral hemisphere metastases and presence of cerebellar metastases were positively correlated (p = 0.001). The prevalence of at least one metastasis surrounded with >2 cm of edema was greater for the lung than for the breast patients (p = 0.019). The primary tumor type, rather than the scanning method, correlated with differences between these variables.

Conclusions

Brain metastases from lung occur earlier, are more edematous, but fewer in number than those from breast cancers. Cerebellar brain metastases are more frequent in breast cancer.     

Three irradiation treatment options including radiosurgery for brain metastases from primary lung cancer

PURPOSE: To determine local control and survival rates in 92 patients with 145 brain metastases treated with three options of radiotherapy including stereotactic radiosurgery (SR). METHODS: Between July 1994 and August 2002, 92 consecutive patients with 145 metastases were treated with a SR, 34 with initially SR alone, 22 initially with an association of whole-brain radiotherapy (WBRT) and 36 with SR alone for recurrent new brain metastasis after WBRT. At time of treatment, extracranial disease was controlled in 46 (50%) and uncontrolled in 46 (50%). Pathologies were adenocarcinoma in 54 cases (59%), squamous cell carcinoma in 14 cases (15%), small cell carcinoma in 10 cases (11%) and miscellaneous in 14 cases (15%). All patients underwent only one treatment fraction for 1 or 2 metastases in 73 cases (83%) and for more than 2 metastases for the others. RESULTS: The characteristics of patients and metastases in the group treated initially with SR alone and in the group treated initially with WBRT+SR were comparable. Median follow-up was 29 months (18-36). Overall, the median and the 1- and 2-year rates of overall survival were, respectively, 9 months, 37 and 20%. A controlled extracranial disease, a high Karnofsky index and a low number of metastasis were independent prognostic factor of overall survival, respectively, HR 0.53 (95% CI 0.31-0.90, P=0.01), HR 0.95 (95% CI 0.92-0.97, P=0.0002), and HR 0.48 (95% CI 0.25-0.90, P=0.02). Thirteen metastases were not controlled (9%). Six-month and 1-year local control rate were, respectively, 93 and 86%. High delivered dose was an independent prognostic factor of local control, HR 0.41 (95% CI 0.18-0.95, P=0.03). A controlled extracranial disease was favourable independent prognostic factor of brain free-disease free survival, HR 0.47 (95% CI 0.2-0.98, P=0.04). Although there was a trend of a better local control, overall and brain disease free survivals rates in the WBRT+SR group compared to SR alone one, the difference were not statistically different. CONCLUSION: Local control and survival rates are acceptable for a palliative treatment for the three option of treatment. In this series, the number of patients is not enough great to conclude to the necessity of the association of WBRT to SR. Re-irradiation is a safe treatment after new metastases appeared in previously irradiated area.     

ALK基因抑制剂治疗非小细胞肺癌脑转移的研究进展

间变性淋巴瘤激酶(ALK)重排是非小细胞肺癌(NSCLC)强有力的致癌驱动基因之一,伴ALK重排的NSCLC患者应用第一代ALK抑制剂如克唑替尼的治疗疗效要远远优于化疗.同时越来越多的研究报道了ALK抑制剂在伴有脑转移的NSCLC患者中的颅内有效率.然而尽管第一代ALK抑制剂治疗ALK阳性NSCLC脑转移有初步的临床数据,但在获得性耐药后,肿瘤出现不同程度的复发,给肿瘤患者的后续治疗带来新的挑战.新一代ALK抑制剂如艾乐替尼、色瑞替尼、AP26113和PF-06463922的相继出现解决了这一问题.     

治疗65例肺癌脑转移探讨

目的：探讨影响肺癌脑转移综合治疗的预后因素及提高生存质量的可能性。方法：１９９０ 年３月～１９９５ 年３ 月间对６５ 例肺癌脑转移患者行单纯放疗及手术切除加放疗。放疗（ 全脑） 分为２ 组：常规放疗剂量２２ ～４０ Ｇｙ／２ ．２ ～４ｗ ,后缩野追加１５ ～２０ Ｇｙ／１ ．５ ～２ｗ ;全脑快速照射剂量１８ ～２４ Ｇｙ／１１ ～１５ｗ ,后缩野追加１５ ～２０ Ｇｙ／１５ ～２０ｗ 。结果：手术切除加放疗的中位生存期９５ 个月和１ 年生存率６２３ ％ ,显著优于单放组的５５ 个月和１４５ ％ （ Ｐ＜ ００５） 。全脑快速照射能迅速缓解症状,未能提高生存率。结论：肺癌脑转移采用手术加放疗的疗效比单纯放疗好。     

SIMULTANEOUS THORACO－CRANIAL OPERATION FOR THE TREATMENT OF LUNG CANCER WITH BRAIN METASTASES

ＳＩＭＵＬＴＡＮＥＯＵＳＴＨＯＲＡＣＯ－ＣＲＡＮＩＡＬＯＰＥＲＡＴＩＯＮＦＯＲＴＨＥＴＲＥＡＴＭＥＮＴＯＦＬＵＮＧＣＡＮＣＥＲＷＩＴＨＢＲＡＩＮＭＥＴＡＳＴＡＳＥＳＣｈｅｎＪｉａｎ陈建；ＬｉｕＤａｏｋｕｎ刘道坤；ＬｉｕＪｕｎｈｕａ刘俊华；ＳｈｉＺｈｏ...     

肺癌脑转移放射治疗方式及进展

肺癌是发病率和死亡率最高的恶性肿瘤,其脑转移发生率高且预后差。近年来随着靶向以及免疫治疗药物相继研制成功,肺癌原发灶局部控制率得以提升,因此对其脑转移的治疗更加关注。放射治疗是肺癌脑转移治疗的重要手段之一,现将肺癌脑转移放射治疗方式及进展进行综述。     

吉非替尼与厄洛替尼治疗非小细胞肺癌脑转移的Meta分析

目的:比较吉非替尼与厄洛替尼治疗非小细胞肺癌脑转移的疗效与安全性.方法:计算机检索pubmed、embaes、中国期刊网全文数据库(CNKI)、万方医学网等数据库,收集吉非替尼与厄洛替尼治疗非小细胞肺癌脑转移的随机对照实验(randomized controlled trial,RCT),用Revman5.3软件进行Meta分析.结果:本文纳入的6个研究中共405名患者,Meta分析显示,在疗效方面,吉非替尼与厄洛替尼有效率、疾病控制率比较无统计学差异(P>0.05);在不良反应方面,厄洛替尼皮疹、恶心呕吐、肝功能损害的发生率均高于吉非替尼(P<0.05).结论:非小细胞肺癌脑转移患者应用吉非替尼和厄洛替尼靶向治疗效果相当,但吉非替尼的不良反应发生率低.     

Chemotherapy for brain metastases in small-cell lung cancer

PURPOSE: Brain metastasis occurs commonly in patients with small-cell lung cancer (SCLC). Herein, we report the efficacy of irinotecan and carboplatin in the treatment of brain metastases from SCLC. In addition, we review the existing data on chemotherapy for brain metastases in SCLC. PATIENTS AND METHODS: Eighty patients with metastatic or relapsed SCLC were enrolled in a phase II trial of irinotecan and carboplatin. Patients naive to chemotherapy were treated with irinotecan 200 mg/m2 and carboplatin AUC of 5, and patients previously treated with chemotherapy received irinotecan 150 mg/m2 and carboplatin AUC of 5, every 21 days for 6 cycles. RESULTS: Among the 80 patients, 15 (19%) presented with brain metastases. An analysis of 14 assessable patients with brain metastases revealed an overall response rate of 65% after 2 cycles of chemotherapy and a median survival of 6 months (range, 1-24 months). Upon review of the literature, 8 studies were identified as having > 10 patients who received chemotherapy for brain metastases from SCLC. Based on these studies, the response rate of brain metastases from SCLC to a variety of chemotherapy and median survival of patients ranged from 22% to 85% and 3 months to 9 months, respectively. CONCLUSION: Chemotherapy, including the regimen of irinotecan and carboplatin, is an effective treatment for SCLC brain metastases.     

榄香烯在原发性肺癌脑转移患者中的应用效果

目的探讨榄香烯在原发性肺癌脑转移患者中的应用效果,旨在为临床治疗原发性肺癌脑转移患者提供相应依据。方法选取2013年1月至2016年2月间江苏省如皋市人民医院收治的72例原发性肺癌脑转移患者,采用随机数表法分成观察组和对照组,每组36例。观察组患者采用三维适形放疗(3D-CRT)行颅内病灶放疗和吉西他滨+顺铂(GP方案)常规化疗治疗的基础上增加榄香烯注射液进行化疗,对照组患者采用3D-CRT行颅内病灶放疗和GP方案常规化疗,连续治疗2周后,观察比较两组患者的临床疗效、不良反应发生情况和一年后的生活质量。结果观察组患者的总有效率为55.6%,高于对照组患者的总有效率30.6%,观察组患者生活质量总分为(72.95±9.15)分,高于对照组患者的(60.87±9.65)分,差异均有统计学意义(均P<0.05)。观察组患者不良反应总发生率为27.8%,低于对照组患者的72.2%,差异有统计学意义(P<0.05)结论榄香烯能够增强原发性肺癌脑转移患者的疗效,提高患者的生存质量,减少不良反应,应用效果显著。