CAJ | 학술논문

目的：评价替莫唑胺联合同步全脑放疗对肺癌脑转移患者的有效性和安全性。方法：收集替莫唑胺联合全脑放疗治疗肺癌脑转移患者24例，全脑放疗总剂量40 Gy，2 Gy/次，5次/周。全脑放疗后，对部分局部病灶三维适形局部加量至50~60 Gy。所有患者于放疗第1天开始给予替莫唑胺75 mg·m-2口服治疗，直至放疗结束，如有不良反应不可耐受则停用化疗药。后续根据患者的系统治疗和耐受情况，患者在放疗结束后接受系统化疗或继续替莫唑胺辅助治疗（150~200 mg·m-2·d-1，5/28天），最多行6周期辅助治疗，评价患者的疗效与不良反应。结果：24例患者全部完成颅脑的同步放化疗，10例患者接受个体化选择的系统化疗，7例接受最佳支持治疗，3例患者接受4个周期替莫唑胺辅助治疗，3例患者接受了6周期辅助治疗。放化疗结束后颅内病灶评价：完全缓解2例，部分缓解7例，稳定12例，进展3例，总有效率37.5%，疾病控制率87.5%，中位PFS为5个月，中位颅内病灶PFS为6个月。18例患者出现治疗相关不良反应，其中3例（12.5%）出现Ⅲ~Ⅳ度血液学毒性反应。4例（16.7%）出现Ⅲ~Ⅳ度非血液学毒性反应。结论：替莫唑胺联合全脑放疗治疗肺癌脑转移疗效较满意，不良反应可耐受，治疗依从性较好，远期生存获益仍需进一步的临床研究予以验证。
목적：평개체막서알연합동보전뇌방료대폐암뇌전이환자적유효성화안전성。방법：수집체막서알연합전뇌방료치료폐암뇌전이환자24례，전뇌방료총제량40 Gy，2 Gy/차，5차/주。전뇌방료후，대부분국부병조삼유괄형국부가량지50~60 Gy。소유환자우방료제1천개시급여체막서알75 mg·m-2구복치료，직지방료결속，여유불량반응불가내수칙정용화료약。후속근거환자적계통치료화내수정황，환자재방료결속후접수계통화료혹계속체막서알보조치료（150~200 mg·m-2·d-1，5/28천），최다행6주기보조치료，평개환자적료효여불량반응。결과：24례환자전부완성로뇌적동보방화료，10례환자접수개체화선택적계통화료，7례접수최가지지치료，3례환자접수4개주기체막서알보조치료，3례환자접수료6주기보조치료。방화료결속후로내병조평개：완전완해2례，부분완해7례，은정12례，진전3례，총유효솔37.5%，질병공제솔87.5%，중위PFS위5개월，중위로내병조PFS위6개월。18례환자출현치료상관불량반응，기중3례（12.5%）출현Ⅲ~Ⅳ도혈액학독성반응。4례（16.7%）출현Ⅲ~Ⅳ도비혈액학독성반응。결론：체막서알연합전뇌방료치료폐암뇌전이료효교만의，불량반응가내수，치료의종성교호，원기생존획익잉수진일보적림상연구여이험증。
Objective:To assess the efifcacy and safety of temozolomide (TMZ) combined with whole brain radiotherapy in the treatment of lung cancer patients with brain metastases.Methods:A total of 24 lung cancer patients with brain metastases were enrolled in this retrospective study. The whole brain radiotherapy with the total dose of 40 Gy (2 Gy per time, 5 times per week) was given to all the patients, and another 10–20 Gy of intensity-modulated boosting therapy for local lesion was given if necessary. All patients took temozolomide (75 mg·m-2) concurrently during the whole course of radiotherapy. Temozolomide should be stopped, if the patient can not tolerate adverse reactions. After radiotherapy, the patients received systematical chemotherapy or continued TMZ therapy (150–200 mg·m-2·d-1, 5/28 d) for additional 0–6 cycles according to the condition of the patients. The efifcacy and adverse reactions were evaluated statistically.Results:All the patients ifnished the radiotherapy combined with concurrent TMZ. Afterwards, 10 patients received systematical chemotherapy, 7 patients received the best supportive treatment, 3 patients received additional 4 cycles of TMZ adjuvant therapy, and 3 patients continued 6 cycles of TMZ chemotherapy. After radiotherapy and chemotherapy, 2 patients had complete response, 7 patients had partial response, 12 patients had stable disease, while the other 3 patients had progressed disease by evaluation of intracranial lesion. Therefore, the total effective rate achieved 37.5%, the disease control rate obtained 87.5%, the median PFS was 5 months, the median intracranial lesions PFS was 6 months. Acute side-effects were developed in 18 patients. GradeⅢorⅣhematologic toxicities were developed in 3 patients (12.5%), but gradeⅢ–Ⅳnon-hematologic side-effects were developed in 4 patients (16.7%).Conclusion:Temozolomide was well tolerant, and showed signiifcant improvements in response rate when combined with whole brain radiotherapy in lung cancer with brain metastases. While, the beneift of long-term survival needs to be veriifed by further clinical studies.