全身化疗同步或序贯脑放疗治疗非小细胞肺癌脑转移患者的疗效与毒副反应

目的 探讨全身化疗同步脑放疗或序贯脑放疗治疗非小细胞肺癌(NSCLC)脑转移患者的疗效和毒副反应.方法 采用前瞻对照方法,将60例NSCLC脑转移患者分为全身化疗同步脑放疗组(同步组)和全身化疗序贯脑放疗组(序贯组),每组各30例.结果 共59例患者完成治疗,总体客观缓解率(ORR)为22.0%,脑转移灶的ORR为35.6%,中位无进展生存期(PFS)为3个月,中位生存期(MST)为16个月,1年和2年总生存率分别为55.0%和24.4%.同步组和序贯组的总体ORR分别为20.0%和24.1%,脑转移灶的ORR分别为43.3%和27.6%,中位PFS分别为3和4个月,MST分别为16和13个月,差异均无统计学意义(均P>0.05).同步组和序贯组的1年生存率分别为58.5%和52.9%(P=0.365),2年生存率分别为37.2%和18.9%,同步组明显优于序贯组(P=0.011).同步组白细胞减少的发生率低于序贯组,差异有统计学意义(P=0.029);其他毒副反应的发生率差异无统计学意义(P>0.05).结论 全身化疗同步脑放疗治疗NSCLC脑转移可以取得较好疗效,且患者耐受性良好.

Abstract：

Objective To evaluate the efficacy, survival and toxicity in patients with brain metastases from non-small cell lung cancer ( NSCLC), treated with concurrent systemic chemotherapy and whole brain radiation therapy (WBRT) or sequential systemic chemotherapy/WBRT.Methods A total of 60 NSCLC patients with brain metastases were divided into two groups in this prospective clinical study:concurrent systemic chemotherapy and WBRT group (concurrent group ) and sequential systemic chemotherapy/WBRT group (sequential group).Results Of 59 assessable patients, the overall response rate was 22.0%, and the brain response rate was 35.6%;the median progression-free survival time was 3.0 months, and the overall 1- and 2-year survival rates were 55% and 24.4%, respectively, with a median survival time of 16.0 months.The overall response rate was 20.0% in the concurrent group and 24.1% in sequential group (P > 0.05 ).The brain response rates of 43.3% in concurrent group and 27.6% in sequential group were also not significantly different (P > 0.05 ).The median progression-free survival time for the patients in the concurrent group was 3.0 months versus 4.0 months in the sequential group, and the median survival time was 16.0 months versus 13.0 months ( all P >0.05 ).The 1- and 2-year survival rates were 58.5% and 37.2% versus 52.9% and 18.9%, respectively, with a significant difference in the 2-year survival rate between the two groups ( P = 0.011 ).In the sequential group, leukopenia was more frequent during chemotherapy than that in the concurrent group ( P = 0.029).Conclusion Concurrent systemic chemotherapy and WBRT is effective with tolerable adverse events in treating brain metastasis from NSCLC with an encouraging survival, and deserves further large sample and randomized multicenter clinical trials.

Concurrent versus sequential systemic chemotherapy and whole brain radiation therapy for brain matastases in non-small-cell lung cancer patients

Objective To evaluate the efficacy, survival and toxicity in patients with brain metastases from non-small cell lung cancer ( NSCLC), treated with concurrent systemic chemotherapy and whole brain radiation therapy (WBRT) or sequential systemic chemotherapy/WBRT.Methods A total of 60 NSCLC patients with brain metastases were divided into two groups in this prospective clinical study:concurrent systemic chemotherapy and WBRT group (concurrent group ) and sequential systemic chemotherapy/WBRT group (sequential group).Results Of 59 assessable patients, the overall response rate was 22.0%, and the brain response rate was 35.6%;the median progression-free survival time was 3.0 months, and the overall 1- and 2-year survival rates were 55% and 24.4%, respectively, with a median survival time of 16.0 months.The overall response rate was 20.0% in the concurrent group and 24.1% in sequential group (P > 0.05 ).The brain response rates of 43.3% in concurrent group and 27.6% in sequential group were also not significantly different (P > 0.05 ).The median progression-free survival time for the patients in the concurrent group was 3.0 months versus 4.0 months in the sequential group, and the median survival time was 16.0 months versus 13.0 months ( all P >0.05 ).The 1- and 2-year survival rates were 58.5% and 37.2% versus 52.9% and 18.9%, respectively, with a significant difference in the 2-year survival rate between the two groups ( P = 0.011 ).In the sequential group, leukopenia was more frequent during chemotherapy than that in the concurrent group ( P = 0.029).Conclusion Concurrent systemic chemotherapy and WBRT is effective with tolerable adverse events in treating brain metastasis from NSCLC with an encouraging survival, and deserves further large sample and randomized multicenter clinical trials.