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目的优化选择非小细胞肺癌脑转移瘤的治疗方案。方法72例均有病理学诊断的住院患者。随机分成3组。全颅外放疗组24例(Ⅰ组)。伽玛刀加全颅放疗组22例(Ⅱ组)。伽玛刀加全颅放疗联合Vm-26治疗组26例(Ⅲ组)。全脑外放疗中心剂量36~41Gy,常规分割4~5周完成。伽玛刀治疗以50%等中心剂量曲线严格覆盖肿瘤边缘,处方剂量16~25Gy,平均16Gy。化疗:于全颅放疗DT19-29Gy,2~3周后,加Vm-26化疗,60mg·m2·d-1,连用3d,21d为1周期,共用2个周期。化疗期间继续放疗。结果Ⅰ、Ⅱ和Ⅲ组的中位生存时间分别为6·0(1·2~19·0)、9·2(4·4~30·0)和10·8(5·2~42·2)个月,1、2年生存率分别为34·6%和12·6%;62·2%和30·2%;70·8%和35·6%。结论采用3种不同方法治疗非小细胞肺癌脑转移瘤,Ⅲ组在提高局部控制率、延长生存期上明显优于Ⅰ组和Ⅱ组,且毒副作用可耐受。
Objective To optimize the treatment of brain metastases of non-small cell lung cancer. Methods 72 cases were pathologically diagnosed in hospitalized patients. Randomly divided into 3 groups. Total extracranial radiotherapy group of 24 patients (Ⅰ group). Gamma Knife Plus total skull radiotherapy group of 22 patients (Ⅱ group). Gamma Knife combined with cranial radiotherapy and Vm-26 treatment group of 26 patients (group Ⅲ). Whole-brain radiotherapy center dose 36 ~ 41Gy, conventional segmentation 4 to 5 weeks to complete. Gamma Knife treatment with 50% isoside center dose curve to strictly cover the tumor margins, the prescription dose of 16 ~ 25Gy, an average of 16Gy. Chemotherapy: In the whole skull radiotherapy DT19-29Gy, 2 to 3 weeks later, plus Vm-26 chemotherapy, 60mg · m2 · d-1, 3d, 21d for 1 cycle, sharing 2 cycles. Radiotherapy continued during chemotherapy. Results The median survival time of group Ⅰ, Ⅱ and Ⅲ were 6.0 (ranged from 1.2 to 19.0), ranged from 9.2 (ranged from 4.0 to 30.0) and ranged from 5.0 to 42.0 2) months, 1, 2-year survival rates were 34.6% and 12.6%; 62.2% and 30.2%; 70.8% and 35.6% respectively. Conclusion Three different methods are used to treat brain metastases of non-small cell lung cancer. Group Ⅲ is superior to group Ⅰ and group Ⅱ in improving local control rate and prolonging survival period, and its side effects can be tolerated.