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目的:观察分析同步TP方案及BCNU放疗治疗非小细胞肺癌(NSCLC)脑转移的疗效、生存率以及不良反应。方法:36例NSCLC脑转移初治患者接受TP方案,紫杉醇130 mg.m-2,24 h持续静脉输注,顺铂(DDP)20 mg.m-2,D1～D3,3周为1个周期;脑部放疗与TP方案同时开始,2 Gy.d-1,每周5 d,脑转移灶1～3个者全脑放疗40 Gy后缩野至60 Gy,脑转移灶>3个者全脑放疗至40 Gy,放疗开始20 Gy后予卡莫司汀(BCNU)80 mg.m-2,D1～D3,6周为1个周期。结果:治疗后84%患者神经系统症状得到改善,对脑转移灶有效率为58.4%,对肺原发灶有效率为55.5%,中位总生存期(MST)11.2个月(95%CI 9.58～13.30),1年生存率为40.2%,2年生存率17.2%,5年生存率为7.1%,单纯脑转移MST13.0个月,显著高于多脏器转移9.7个月(P=0.035)。常见不良反应为白细胞减少,Ⅲ～Ⅳ度发生率50%,经对症治疗后好转,恶心、呕吐,肌肉关节痛以Ⅰ～Ⅱ度为主,发生率均为16.7%。结论:TP方案及卡莫司汀联合全脑放射治疗NSCLC脑转移的近期疗效高并延长了中位生存期,不良反应耐受性好,可考虑作为NSCLC脑转移的治疗方案。
OBJECTIVE: To observe and analyze the efficacy, survival rate and adverse reactions of synchronous TP regimen and BCNU radiotherapy in the treatment of non-small cell lung cancer (NSCLC) brain metastases. Methods: Thirty-six NSCLC patients with brain metastases undergoing TP regimen were treated with paclitaxel at 130 mg.m-2 and 24 h with continuous intravenous infusion of cisplatin (DDP) at 20 mg.m-2 and D1-D3 at 1 week The brain radiotherapy and TP regimen started at the same time. 2 Gy.d-1, 5 d week and 1 ~ 3 brain metastases were reduced to 60 Gy after whole-brain radiotherapy 40 Gy, and brain metastases> 3 Whole brain radiotherapy to 40 Gy, radiotherapy after the start of 20 Gy to carmustine (BCNU) 80 mg.m-2, D1 ~ D3, 6 weeks for a cycle. RESULTS: Neurological symptoms were improved in 84% of patients after treatment, with an effective rate of 58.4% for brain metastases, 55.5% for primary lung tumors, and 11.2 months for median overall survival (MST) (95% CI 9.58 ~ 13.30). The 1-year survival rate was 40.2%, the 2-year survival rate was 17.2%, and the 5-year survival rate was 7.1%. The MTS of simple brain metastasis was 13.0 months, significantly higher than that of multiple organ metastasis of 9.7 months (P = 0.035 ). Common adverse reactions were leukopenia, the incidence of Ⅲ ~ Ⅳ degrees 50%, after symptomatic treatment improved, nausea, vomiting, muscle and joint pain in grade Ⅰ ~ Ⅱ, the incidence was 16.7%. CONCLUSION: TP regimen combined with carmustine and whole brain radiation therapy has a good short-term efficacy and prolonged median survival in NSCLC patients with brain metastases. The adverse reactions are well tolerated and may be considered as a treatment for NSCLC brain metastases.