后程适形放疗联合羟基喜树碱同步化疗治疗非小细胞肺癌脑转移的临床观察

目的观察后程三维适形放疗(three-dimensional conformal radiation therapy,3D-CRT)联合羟基喜树碱(10-hydroxycamptothecin,HCPT)同步化疗治疗非小细胞肺癌(non-small cell lung cancer,NSCLC)脑转移的疗效及不良反应。方法134例患者随机分为放疗加化疗组68例(放化组)和单纯放疗组66例(放疗组)。两组前程均行普通二维放疗,在全脑照射总剂量(total dose,DT)30~40 Gy后,后程缩野对脑转移癌局部病灶行3D-CRT,每次2 Gy,每周5次,加量DT 10~24 Gy,至DT 50~64 Gy。放化组放疗2~4周,其间给予HCPT 6 mg/m2静脉滴注,每日1次,连用7天同步化疗,观察两组疗效及不良反应。结果放化组完全缓解(CR)、部分缓解(PR)分别为16.2%和67.6%,而放疗组分别是7.6%和50.0%,放化组有效率(CR PR)明显高于放疗组(P<0.05)。放化组和放疗组1、2年生存率分别是33.8%、2.9%和30.3%、1.5%,其差异均无统计学意义。放化组白细胞下降、恶心呕吐的发生率较放疗组高。结论后程3D-CRT联合HCPT同步化疗治疗NSCLC脑转移可明显提高近期疗效,不良反应虽有所增加,但患者能耐受。

Clinical observation of three-dimensional conformal radiation therapy for post period concurrently combined with chemotherapy of 10-hydroxycamptothecin for brain metastases from non-small cell lung cancer

Objective To evaluate the efficacy and the adverse reaction of three-dimensional conformal radiation therapy(3D-CRT) for the post period concurrently combined with chemotherapy of 10-hydroxycamptothecin(HCPT) for brain metastases from non-small cell lung cancer(NSCLC).Methods A total of 134 patients were randomly divided into radiochemotherapy group(n=68) and radiotherapy group(n=66).In the early stage,the two groups all received common two-dimesional conformal radiation therapy.The tumor dose(DT) of the whole brain irradiation was 30-40 Gy,in the later stage,the reduced field for the local lesion of brain metastases would be altered to 3D-CRT for the post period whose method was 2 Gy a time,5 times a week.DT was added from 10-24 Gy and the total DT was 50-64 Gy.The patients were given HCPT 6 mg per squre meters by intravenous drip every day with synchronization for 7 days during 2-4 weeks' radiotherapy period in radiochemotherapy group.The efficacy and adverse effects of two groups were observed.Results The complete response rate(CR) and partly response rate(PR) were 16.2% and 67.8% in radiochemotherapy group and 7.6% and 50.0% in radiotherapy group respectively,with statistic significance(P<0.05).The 1-,2-year survival rates were 33.8%,2.9% in radiochemotherapy group,and 30.3%,1.5% in radiotherapy group respectively,without statistic significance.The complications such as leucopoenia,nausea and vomiting were more common in radiochemotherapy group than those of the other group.Conclusion 3D-CRT concurrently combined with chemotherapy is rather active for locally advanced brain metastases from NSCLC in short-term outcome.More side effects and adverse reaction are observed in radiochemotherapy group;however,all the patients could tolerate.