吉非替尼治疗老年非小细胞肺癌化疗后脑转移的效果分析

目的 研究探讨吉非替尼治疗老年非小细胞肺癌化疗后脑转移的效果及安全性.方法 选择本院2009年6月至2012年6月收治的年龄≥60岁的非小细胞肺癌伴脑转移患者42例,均应用吉非替尼治疗,观察颅内外病灶的近期疗效及远期疗效(疾病进展时间TTP曲线及总生存时间OS曲线),并分析不同临床病理参数下中位TTP和中位OS,以评价吉非替尼治疗的控制效果.结果 42例患者颅内病灶RR率为33.3％,DCR率为97.6％;颅外病灶RR率为31.0％,DCR率为92.9％.42例患者中,有4例患者未进展,38例进展,平均中位TTP为245 d;截止到随访终止日或死亡日期,4例存活,38例死亡,平均中位OS为590 d,1年内生存率为76.2％(32/42),2年内生存率为11.9％(5/42).经统计,不同年龄段、性别、吸烟史、发生脑转移的时间、脑转移灶数目、吉非替尼治疗时机、放疗时间方面,均为影响TTP和OS的独立危险因素.结论 吉非替尼治疗老年非小细胞肺癌化疗后脑转移的效果值得肯定,安全性较好,其中以单发脑转移、一线治疗时机、同步放疗等患者应用吉非替尼治疗控制效果更好.

Gefitinib for brain metastasis after chemotherapy in elderly patients with non-small cell lung cancer

Objective To investigate the effect and safety of gefitinib in the treatment of brain metastasis after chemotherapy in elderly patients with non-small cell lung cancer.Methods 42 ＞60 years old patients with non-small cell lung cancer complicated with brain metastasis admitted into our hospital from June,2009 to June,2012 were selected and treated with gefitinib.The short-and long-term efficacies of intracranial and extracranial lesions [time to progression (TTP) curve and total survival time OS curve] were observed.The median TTP and OS of different clinical pathological parameters were analyzed to evaluate the control effect by gefitinib.Results The rate of RR was 33.3％ and that of DCR 97.6％ in intracranial lesions and that of RR 31.0％ and that of DCR 92.9％ in extracranial lesions.Among the 42 patients,4 hadn't progressed and 38 had progressed and the average median TTP was 245 d;until the end of the follow-up or the death date,4 survived,38 died,the median OS was 590 d,the 1 year survival rate was 76.2％ (32/42),and the 2 year survival rate was 11.9％ (5/42).The independent risk factors of OS and TTP were different age range,sex,smoking history,the time of brain metastasis,the number of brain metastases,gefitinib treatment timing,and radiotherapy time.Conclusions Gefitinib in the treatment of brain metastasis after chemotherapy in elderly patients with non-small cell lung cancer is effective and safe.Gefitinib for patients with single brain metastasis or first-line treatment timing or undergoing synchronous radiotherapy,etc.has better control effect.