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背景与目的:近年来肺癌脑转移的发病率随着支气管肺癌的发病率逐年增加而明显上升,文献报道达30%~50%。放射治疗是治疗脑转移的主要手段,而目前为止化疗与放疗联合治疗脑转移的研究较少。本研究旨在比较支气管肺癌脑转移同步放化疗与单放疗的临床疗效、生存率和毒性反应。方法:自2000年9月至2001年10月将41例支气管肺癌患者随机分组,其中20例进入同步放化疗组,21例进入单放疗组。同步放化疗组中,男性14例,女性6例,平均年龄50岁(范围40~70岁),非小细胞肺癌16例,小细胞癌4例;单放疗组中,男性14例,女性7例,平均年龄52岁(范围40~73岁),非小细胞肺癌19例,小细胞癌2例。同步放化疗组化疗方案:鬼臼噻吩甙(VM26)每天60 mg/m2,d1~3;顺铂(DDP)60 mg/m2,d1;放射治疗从化疗第1天开始,6MV-X线照射,3Gy/次,全脑照射二周总剂量为30Gy/10次。单放疗组:放射治疗方案同同步放化疗组。结果:全组所有患者均按计划完成治疗。同步放化疗组完全缓解率(CR)为25%,部分缓解率(PR)为50%,无变化(SD)为25%。单放疗组CR为4.76%,PR为33.33%,无变化(SD)为61.9%。两组的CR率及有效率(CR+PR)均有显著性差异(P=0.011,P=0.019)。同步放化疗组的1、2、4年生存率分别为44.44%、33.33%、11.11%,中位生存时间为14月。单放疗组的1、2、4年生存率为31.58%、26.67%、0%,中位生存时间为11月。两组无显著性差异(P=0.2015)。毒副反应:同步放化疗组Ⅲ/Ⅳ度白细胞下降(40%),血小板下降(25%)和胃肠道反应(50%)与单放疗组比(4.76%,0,9.52%),均有显著性差异(P=0.007,P=0.016,P=0.005)。结论:对支气管肺癌脑转移治疗同步放化疗的方案,其近期有效率优于单放疗,并且有提高远期生存率的可能性,虽毒副反应增加,但患者均能耐受。
BACKGROUND & OBJECTIVE: In recent years, the incidence of brain metastases of lung cancer has increased significantly with the increasing incidence of bronchial lung cancer, reported in the literature up to 30% to 50%. Radiation therapy is the main method of treatment of brain metastases, and so far the combination of chemotherapy and radiotherapy in the treatment of brain metastases less. The aim of this study was to compare the clinical efficacy, survival and toxicity of concurrent chemoradiotherapy with single radiotherapy for brain metastases of bronchial carcinoma. Methods: From September 2000 to October 2001, 41 patients with bronchogenic carcinoma were randomly divided into two groups. Of them, 20 patients entered the concurrent chemoradiation group and 21 patients received the single radiotherapy group. In the concurrent chemoradiotherapy group, there were 14 males and 6 females with an average age of 50 years (range 40-70 years), 16 cases of non-small cell lung cancer and 4 cases of small cell carcinoma. In the single radiotherapy group, 14 males and 7 females For example, the average age of 52 years (range 40 to 73 years), 19 cases of non-small cell lung cancer, 2 cases of small cell carcinoma. Chemotherapy of concurrent chemoradiation chemotherapy: Diazepam (VM26) daily 60 mg / m2, d1 ~ 3; DDP 60 mg / m2, d1; Radiation therapy from the first day of chemotherapy, 6MV-X irradiation , 3Gy / time, total brain irradiation for two weeks the total dose of 30Gy / 10 times. Single radiotherapy group: Radiation therapy program with the same radiotherapy and chemotherapy group. Results: All patients in the group completed the treatment according to plan. The rate of complete remission (CR) was 25%, partial response rate (PR) was 50%, and no change (SD) was 25% in the concurrent chemoradiation group. In the single radiotherapy group, CR was 4.76%, PR was 33.33%, and no change (SD) was 61.9%. The CR rate and effective rate (CR + PR) in both groups were significantly different (P = 0.011, P = 0.019). The 1, 2, 4-year survival rates of concurrent chemoradiotherapy group were 44.44%, 33.33%, 11.11% respectively, and the median survival time was 14 months. The 1, 2, 4-year survival rates of single radiotherapy group were 31.58%, 26.67%, 0%, and the median survival time was November. There was no significant difference between the two groups (P = 0.2015). Toxic and side effects: The ratio of leukopenia (40%), thrombocytopenia (25%) and gastrointestinal reaction (50%) in group Ⅲ / Ⅳ with concurrent radiotherapy and chemotherapy were 4.76%, 0,9.52% There was a significant difference (P = 0.007, P = 0.016, P = 0.005). CONCLUSION: The schedule of concurrent chemoradiotherapy for brain metastasis of bronchogenic carcinoma of lung is more effective than monotherapy in the short term, and the possibility of improving the long-term survival rate is increased. However, the patients are tolerant.