VmP方案和全脑放射序贯治疗小细胞肺癌脑转移

背景与目的:单纯化疗或全脑放射治疗(wholebrainradiotherapy,WBRT)姑息性治疗小细胞肺癌(smallcelllungcancer,SCLC)脑转移,生存期均较短,本研究前瞻性观察比较VmP化疗方案与WBRT的不同序贯方法治疗SCLC脑转移患者的疗效、不良反应和生存期。方法:38例SCLC并脑转移初治患者根据使用床位非随机地分为A、B两组,经四格表精确概率法检验两组无显著差异(P>0.05)。A组(VmP-WBRT)采用先化疗2周期后放疗的治疗方法,B组(WBRT-VmP)采用先放疗后化疗2周期的治疗方法。化疗方案VmP:鬼臼噻吩甙(Teniposide,Vm-26)60mg/m2d1～5,顺铂(cisplatin,DDP)25mg/m2d1～3,4周为一治疗周期;WBRT方案:多灶性脑转移患者2周内放疗3Gy×10次;单灶脑转移患者在WBRT后1周内缩野放疗3Gy×5次。序贯治疗完成后继续化疗2～4周期。结果:两组病人治疗后80%以上的患者神经症状改善,两组脑转移癌、肺原发癌有效率和RECIST总客观有效率分别为68.2%和75.0%(P=0.647),77.3%和75.0%(P=0.871),63.6%和56.3%(P=0.646);肿瘤进展时间(timetoprogressions,TTP)分别为6.0个月(95%CI4.4～7.6)和5.0个月(95%CI3.6～6.4)(P=0.383);中位生存期(mediansurvivaltime,MST)分别为12.0个月(95%CI7.9～16.1)和9.0个月(95%CI5.6～12.4)(P=0.049);1年和2年生存率分

Sequential treatment of VmP regimen and whole brain radiotherapy for small cell lung cancer patients with brain metastases

BACKGROUND & OBJECTIVE: Median survival time (MST) of small cell lung cancer (SCLC) patients with brain metastases was short when patients were palliatively treated with either chemotherapy or whole brain radiotherapy (WBRT). This study was designed to compare therapeutic effects,toxicities,and survival time of 2 different sequential treatments of VmP regimen and WBRT for SCLC patients with brain metastases. METHODS: According to bed availability, 38 naive SCLC patients with brain metastases were nonrandomized into group A and group B. There was no significant difference of characteristics between 2 groups (Chi-s Fisher's exact test, P >0.05). Patients in group A (VmP-WBRT) received 2 cycles of VmP regimen (teniposide, 60 mg/m(2),d(1-5), cisplatin, 25 mg/m(2), d(1-3), repeated every 4 weeks),and then WBRT (3 Gy x 10,within 2 weeks); patients in group B (WBRT-VmP) received the same WBRT in advance,and then 2 cycles of VmP regimen. Patients with single brain lesion received an extra 3 Gy x 5 radiotherapy on the limited field of brain lesion within 1 week after WBRT. All patients received 2-4 cycles of chemotherapy after sequential treatments. RESULTS: Both sequential treatments relieved neurological symptoms of more than 80% of patients. Response rates of brain,lung,and total lesions of group A and B had no significant differences (68.2% vs. 75.0%, P=0.647; 77.3% vs. 75%, P=0.871; 63.6% vs. 56.3%, P=0.646,respectively). Time to progression (TTP) of group A was 6.0 (95% CI 4.4-7.6) months,of group B was 5.0 (95% CI 3.6-6.4) months (P=0.383). MST of group A was 12.0 (95% CI 7.9-16.1) months,of group B was 9.0 (95% CI 5.6-12.4) months (P=0.049). One-year survival rate of group A was 31.8%,of group B was 18.8% (P=0.281),and 2-year survival rates were 13.6%, and 6.3% (P=0.844). Myelosuppression was the main concentration-dependent toxicity. Incidence of vomit at stage III in group B was higher than that in group A (P=0.01). All treatment toxicities were tolerable and manageable. CONCLUSION: Both sequential treatments can be safely performed for SCLC patients with brain metastases, may relieve neurological symptoms, and well control both primary and metastatic lesions. VmP-WBRT sequential treatment may prolong survival time of SCLC patients for 3 months.