厄洛替尼联合全脑放疗治疗肺腺癌伴脑转移的临床观察

目的 探讨厄洛替尼联合全脑放疗（WBRT）治疗肺腺癌伴脑转移的临床疗效及不良反应。方法 选取2011年1月至2012年6月我院收治的肺腺癌伴脑转移患者42例，随机分为治疗组（n=22）和对照组（n=20）。治疗组患者给予厄洛替尼150mg口服，每日1次；同时行WBRT，总剂量为30～36Gy／10～12次，3Gy／次，5次／周，若脑转移病灶为1～2个，WBRT 30～36Gy后，缩野脑转移灶加量16～20Gy／8～10次／2周。对照组患者先行全身化疗2个周期，然后行WBRT，放疗方法同治疗组。ECOG评分为0～1分患者采用AP方案（培美曲塞 500mg／m2，第1天；顺铂25mg／m2，静脉滴注，第1～3天）或DP方案（多西他赛75mg／m2，第1天；顺铂25mg／m2，静脉滴注，第1～3天），ECOG评分2分患者给予单药培美曲塞化疗，21天为1个周期。观察两组患者的近期疗效、不良反应及生存情况。结果 42例患者均可评价疗效。治疗组和对照组脑转移灶的RR分别为 86.4％、70.0％，差异无统计学意义（P＞0.05）。治疗组和对照组肺癌原发灶的RR分别为 40.9％、35.0％，差异无统计学意义（P＞0.05）。治疗组和对照组的中位TTP分别为8.5个月和4.5个月，差异无统计学意义（P＞0.05）。治疗组和对照组的中位OS分别为14.0个月和9.8个月，差异无统计学意义（P＞0.05）。治疗组和对照组的1年生存率分别为59.1％和45.0％，2年生存率分别为27.3％和15.0％，差异均无统计学意义（P＞0.05）。治疗组不良反应仅为皮疹和腹泻，多数为1～2级，患者可耐受，无明显骨髓抑制或消化道反应；对照组主要为骨髓抑制、恶心和呕吐等消化道反应，经对症处理后好转。结论 厄洛替尼联合WBRT治疗肺腺癌伴脑转移能延长患者的生存时间，且患者耐受性良好。

Clinical observation of erlotinib combined with whole brain radiotherapy for lung adenocarcinoma with brain metastases

Objective To investigate the efficacy and side effects of erlotinib plus whole brain radiotherapy（ WBRT） in the treatment of lung cancer with brain metastases. Methods Forty-two cases of lung cancer with brain metastases patients from January2011 to June 2012 in our hospital were randomly divided into treatment group（ n = 22） and control group（ n = 20）. 22 patients in treatment group were treated with erlotinib 150 mg orally,once per day,combined with WBRT with total dose of 30 ~ 36 Gy,3Gy per fraction,five times per week. If the number of brain metastatic lesions were 1-2,shrinkage wild of brain metastases should need extral 16-20 Gy /8-10 times after WBRT. Twenty patients in control group were received chemotherapy for 2 cycles（ 21 days was a cycle）,and then treated with WBRT,with the same dose and method to treatment group. Patients with ECOG scored 0-1 points were treated by AP or DP solutions. Patients with ECOG scored 2 points were treated with pemetrexed chemotherapy. The curative effects,the survival rate and adverse reaction of two groups were observed and evaluated. Results A total of 42 patients could be evaluated. The RR of brain metastases in treatment group and control group was 86. 4% and 70. 0%,respectively（ P 〉 0. 05）. The RR of lung primary tumor in treatment group and control group was 40. 9% and 35. 0%,respectively（ P 〉 0. 05）. The median progress free survival was 8. 5months in treatment group and 4. 5 months in the control group（ P 〉 0. 05）. The median survival time was 14. 0 months in the treatment group and 9. 8 months in the control group（ P 〉 0. 05）. 1-year survival rate of two groups were 59. 1% and 45. 0%,and 2-year survival rates were 27. 3% and 15. 0%,respectively. They were no statistically significant difference（ P 〉 0. 05）. The main adverse reactions in treatment group were only rash and diarrhea,mostly gradeⅠ-Ⅱ,which could be tolerated. The obvious bone marrow suppression and gastrointestinal side effects had no occurrence. In the