32 例肺癌脑转移综合治疗疗效探讨

目的：分析32例肺癌脑转移综合治疗效果,探讨晚期肺癌综合治疗的意义.方法：32例患者均先行“全脑预防照射＋转移灶同步适形放疗加量”即“大野套小野”治疗.放疗同时予全身化疗2个周期,颅脑放疗完成后对肺原发灶进行适形放疗,肺部放疗结束后巩固化疗2－4个周期,治疗期间或治疗后,酌情辅助以“清热解毒、补气养血”为主的中医扶正治疗.结果：随访率为96.9%,颅内高压症状发生率100.0%,白细胞减少发生率1级37.5%（12例）、2级46.9%（15例）、3级12.5%（4例）、4级3.0%（1例）,放射性肺炎发生率15.6%（5例）.肺部原发灶：完全缓解（CR）15例（46.9%）,部分缓解（PR）14例（43.8%）,稳定（SD）3例（9.4%）,总有效率（ORR）90.7%.脑转移灶：CR 25例（78.1%）,PR 7例（21.9%）,ORR 100.0%.全组中位生存22个月,1、2、3、4年生存率分别为81.3%、46.9%、28.1%、6.3%.结论：肺癌脑转移病人经全身综合治疗可获得较好的近期疗效和短期生存率,积极的综合治疗对晚期肺癌病人仍有临床价值.

Effect of comprehensive treatment for 32 cases of lung cancer patients with brain metastasis

Objective：To analyze the comprehensive treatment effect of 32 cases of lung cancer patients with brain metastasis,discuss the significance of comprehensive treatment in advanced lung cancer patients. Methods：Thirty - two lung cancer patients with brain metastasis were treated with prophylactic cranial irradiation（PCI） and metastasis simultaneously integrated boost conformal therapy that is “field - in - field” therapy. Systemic chemotherapy 2 cycles concurrent with the radiotherapy,received 2 - 4 weeks of consolidation ehemotherapy after lung radiation therapy. Dur- ing the treatment or after treatment,auxiliary application of Fuzheng TCM treatment was used. Results：The follow - up visit rate was 96.9% ,the incidence rate of intracranial hypertension symptoms was 100.0% ,the incidence rates of 1 , 2,3,4 grade leukocytopenia were 37.5% （ 12 cases） ,46.9% （ 15 cases） , 12.5% （4 cases） ,3.0% （ 1 case）, respec- tively. The incidence rate of radiation pnemnonitis was 15.6% （5 eases）. The curative effect of the lung primary tmnor was as follows,the complete response（CR） rate,partial response（PR） rate,stable disease（SD） rate,and overall re- sponse rate （ORR） were 46.9% ,43.8% , 9.4% , 90.7% , respectively. The curative effect of the brain metastasis were the CR rate,PR rate,and ORR 78.1% ,21.9% ,100.0% ,respectively. The median survival time（MST） of all patients was 22 months,the 1 - ,2 - ,3 - ,4 -year smwival rates were 81.3% ,46.9% ,28.1% ,6.3% respectively. Conclusion：Lung cancer patients with brain metastasis can acquire better efficacy and short - term survival rate by systemic therapy, positive treatment for patients with advanced lung cancer still have clinical value.