HTP方案联合全脑放疗治疗肺癌脑转移的临床观察

目的:评价羟基喜树碱、替尼泊甙和顺铂组成的HTP方案联合全脑放疗治疗肺癌脑转移的有效性和安全性。方法:34例肺癌脑转移患者,采取化疗-放疗-化疗的治疗顺序,即先接受HTP方案化疗2周期,第2周期化疗结束后休息2周,接受全脑放疗;放疗结束后休息2周,化疗有效和稳定的患者继续接受原方案化疗2~4周期。HTP方案具体用法为:羟基喜树碱(HCPT)6~8mg/d,静脉滴注,d1~d5;替尼泊甙(VM-26)100mg/d,静脉滴注,d1~d4;顺铂(PDD)20mg/d静脉滴注d1~d5。注意血象和造血细胞因子支持。每4周重复。放射治疗采用6MV-X线全脑照射,2Gy/次,每日1次,每周5日,DT30~46Gy。每2周期化疗结束行疗效评价。结果:完成化疗-放疗-化疗的患者共30例,客观CR0例,PR14例,SD12例,PD4例,有效率(CR PR)为46.7%,疾病控制率(CR PR SD)为86.7%。而单纯颅内病灶评价为:CR4例,PR21例,SD5例,PD0例,有效率(CR PR)为83.3%。20例伴神经系统症状者,完成化疗-放疗-化疗后,19例患者症状得到缓解,15例患者一般状况得到明显改善(KPS评分提高≥20分)。肿瘤进展时间(TTP)为2~32个月,中位TTP为7个月;总生存期(OS)为5~49个月,中位生存期(MST)为10个月。骨髓抑制和脱发是主要不良反应。结论:HTP方案联合全脑放疗对肺癌脑转移具有较好的疗效,生存期得到延长,值得进一步观察研究。

Sequential treatment of HTP regimen and whole brain radiotherapy for lung cancer patients with brain metastases

Objective:To evaluate the efficacy and tolerance of sequential treatment of HTP regimen and whole brain radiotherapy for lung cancer patients with brain metastases.Methods:Thirty-four lung cancer patients with brain metastases received two cycles of HTP regimen ( HCPT 6-8mg/m2 d1-d5, teniposide 100mg d1-d4, cisplatin 20mg d1-d5, repeated every 28 days),and then received the whole brain radiotherapy with a mid-plane dose of 30-46Gy in 15-23 fractions over 3-5 weeks. Patients who achieved CR, PR or SD continued to receive HTP regimen 2-4 cycles.Results:Thirty patients could be evaluated the efficacy.The overall objective response rate and disease control rate were 46.7% and 86.7%,including CR 0 case,PR 14cases,SD 12 cases,PD 4 cases.The objective response rate of encephalic lesion was 83.3%, including CR 4cases,PR 21cases,SD 5 cases,PD 0 cases.Median time to progession was 7 months,median overall time was 10 months.Myelosuppression and alopecia were the main toxicity.Neurological symdrome was improved in 19 patients.Conclusion:The sequential treatment of HTP regimen and whole brain metastases was effective for lung cancer with brain metastases.G-CSF should be prophylacticly used after HTP regimen.