CAJ | 학술논문

目的评价吉非替尼联合放射治疗(简称放疗)在非小细胞肺癌脑转移患者治疗中的效果.方法回顾性分析2001年1月至2010年1月第三军医大学新桥医院全军肿瘤研究所收治的161例非小细胞肺癌脑转移患者的临床资料,其中联合治疗组38例,年龄38～ 77岁,在普通全脑放疗或立体定向放疗的同时服用吉非替尼250 mg,1次/d,连续服用至少8周,于开始服用吉非替尼的第12周进行疗效和毒副反应评价；常规治疗组123例,年龄37—76岁,同期进行普通全脑放疗或立体定向放疗.以x2检验评价两组间客观有效率、疾病控制率、脑转移相关症状及Ⅲ～Ⅳ度毒副反应,以非参数等级检验分析两组美国东部肿瘤协助组体能状态评分(ECOG)间的差异.结果联合治疗组的客观有效率和疾病控制率分别为31.6％和78.9％,显著高于常规治疗组的15.4％和60.2％,差异均有统计学意义(x2 =4.859,P=0.027和x2=4.479,P=0.034)；脑转移相关症状两组间治疗前无明显差异(X2=2.773,P=0.096),治疗后联合治疗组的改善率显著高于常规治疗组(X2=4.612,P=0.037)；联合治疗组治疗前ECOG评分等级0～1分18例,2分11例,3～4分9例,治疗后ECOG评分相应等级分别为27、6、5例,治疗后ECOG评分明显好于治疗前(Z=-2.012,P=0.044)；在Ⅲ～Ⅳ度毒副反应中,联合治疗组发生痤疮样皮疹4例,而常规治疗组为0例(P=0.003),而两组疲乏、恶心呕吐、腹泻、骨髓抑制等的发生差异无统计学意义.结论吉非替尼联合放疗对提高非小细胞肺癌脑转移患者的近期治疗效果、改善生存质量有一定作用,毒副反应可以耐受.
목적 평개길비체니연합방사치료(간칭방료)재비소세포폐암뇌전이환자치료중적효과.방법 회고성분석2001년1월지2010년1월제삼군의대학신교의원전군종류연구소수치적161례비소세포폐암뇌전이환자적림상자료,기중연합치료조38례,년령38～ 77세,재보통전뇌방료혹입체정향방료적동시복용길비체니250 mg,1차/d,련속복용지소8주,우개시복용길비체니적제12주진행료효화독부반응평개；상규치료조123례,년령37—76세,동기진행보통전뇌방료혹입체정향방료.이x2검험평개량조간객관유효솔、질병공제솔、뇌전이상관증상급Ⅲ～Ⅳ도독부반응,이비삼수등급검험분석량조미국동부종류협조조체능상태평분(ECOG)간적차이.결과 연합치료조적객관유효솔화질병공제솔분별위31.6％화78.9％,현저고우상규치료조적15.4％화60.2％,차이균유통계학의의(x2 =4.859,P=0.027화x2=4.479,P=0.034)；뇌전이상관증상량조간치료전무명현차이(X2=2.773,P=0.096),치료후연합치료조적개선솔현저고우상규치료조(X2=4.612,P=0.037)；연합치료조치료전ECOG평분등급0～1분18례,2분11례,3～4분9례,치료후ECOG평분상응등급분별위27、6、5례,치료후ECOG평분명현호우치료전(Z=-2.012,P=0.044)；재Ⅲ～Ⅳ도독부반응중,연합치료조발생좌창양피진4례,이상규치료조위0례(P=0.003),이량조피핍、악심구토、복사、골수억제등적발생차이무통계학의의.결론 길비체니연합방료대제고비소세포폐암뇌전이환자적근기치료효과、개선생존질량유일정작용,독부반응가이내수.
Objective To evaluate the efficacies of gefitinib plus radiotherapy in the treatment of brain metastases in non-small-cell lung carcinoma (NSCLC) patients.Methods A retrospective analysis was conducted for 161 NSCLC patients with brain metastases treated in Xinqiao Hospital from January 2001 to January 2010.And 38 patients aged 38 - 77 years old received the combined regimen of gefitinib plus radiotherapy.It consisted of synchronically practicing general or stereotactic brain radiotherapy and an oral intake of gefitinib (250 mg,QD for at least 8 consecutive weeks).The efficacies and toxicity were evaluated at Week 12 after the initial treatment.A total of 123 patients aged 37 - 76 years old undergoing whole brain or stereotactic radiotherapy were used as control.X2 test between two groups was carried out to evaluate the objective response rate (ORR),disease control rate (DCR),brain metastasis related symptoms and Ⅲ - Ⅳ degree of toxicity. Non-parametric rank tests were performed to compare the U.S. Eastern Cooperative Oncology Group (ECOG) performance status score between two groups. Results In the combination therapy group,the levels of ORR and DCR were significantly higher than those in the conventional treatment group (31.6％,78.9％ vs 15.4％,60.2％ ).The differences were statistically significant ( x2 =4.859,P =0.027 and X2 =4.479,P =0.034) ; significant difference existed in brain metastasis-related symptoms between two groups (x2 =4.612,P =0.037) ; the ECOG scores were evaluated in the combination therapy group.And they were as follows:0 - 1 ( n =18 ),2 ( n =11 ),3 - 4 ( n =9) at pre-treatment vs 0 - 1 ( n =27),2 ( n =6),3 - 4 ( n =5 ) at post-treatment.The ECOG score significantly improved after treatment (Z =-2.012,P =0.044).Regarding the Ⅲ-Ⅳ degree of toxicity,the combination therapy group had 4 patients with acne-like rash and it was significantly higher than that in the conventional therapy group ( n =0) (P =0.003).But no difference existed in the occurrence of fatigue,nausea,vomiting,diarrhea and myelosuppression. Conclusion The combined regimen of gefitinib plus radiotherapy can improve the therapeutic efficacies of brain metastases and enhance the quality-of-life in NSCLC patients,side effects are tolerable.