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目的探讨替莫唑胺维持化疗对小细胞肺癌脑转移的预防作用。方法采用前瞻、对照研究,将初治放化疗后达到完全缓解或部分缓解的小细胞肺癌患者50例分为治疗组(n=30)和对照组(n=20)。治疗组在放化疗结束后使用替莫唑胺维持化疗,对照组行预防性全脑照射(PCI)。统计分析两组患者脑转移阳性率,总生存期及1年生存率。分别记录两种治疗方案发生的不良反应。结果替莫唑胺化疗组与PCI组脑转移阳性率差异无统计学意义(16.7% vs.15.0%,P>0.05)。替莫唑胺化疗组患者中位生存时间为31个月,1年生存率为86.3%;PCI组患者中位生存时间为24个月,1年生存率为79.1%;二者生存情况差异无统计学意义(P>0.05)。替莫唑胺化疗组不良反应主要是血液学反应及胃肠道反应,均为轻、中度。PCI组急性反应主要为头晕恶心,部分患者发生远期神经系统不良反应。结论替莫唑胺维持化疗对降低小细胞肺癌脑转移率的疗效不差于传统PCI治疗,且不良反应为轻、中度,安全可行。
Objective To investigate the preventive effect of temozolomide on chemotherapy-induced brain metastases of small cell lung cancer. Methods Fifty patients with small cell lung cancer who achieved complete remission or partial remission after initial radiotherapy and chemotherapy were divided into treatment group (n = 30) and control group (n = 20) by prospective and controlled study. The treatment group was treated with temozolomide after chemoradiotherapy and the control group received prophylactic whole-brain irradiation (PCI). Statistical analysis of two groups of patients with positive rate of brain metastases, overall survival and 1-year survival rate. Record the adverse reactions of two kinds of treatment plan respectively. Results There was no significant difference in the positive rates of brain metastases between the temozolomide chemotherapy group and the PCI group (16.7% vs.15.0%, P> 0.05). The median survival time of patients in the temozolomide chemotherapy group was 31 months and the 1-year survival rate was 86.3%. The median survival time in the PCI group was 24 months and the 1-year survival rate was 79.1%. There was no significant difference in survival between the two groups (P> 0.05). Adverse reactions in the temozolomide chemotherapy group were mainly hematological reactions and gastrointestinal reactions, both mild and moderate. Acute reactions of PCI group are mainly dizziness and nausea, and some patients have long-term adverse reactions of the nervous system. Conclusion The effect of temozolomide maintenance chemotherapy on reducing the rate of brain metastases of small cell lung cancer is not worse than that of traditional PCI and the adverse reactions are mild, moderate and safe.