立体定向放疗联合全脑放疗和福莫司汀治疗脑转移瘤的临床观察

于兰; 张小涛; 张真; 韩淑红; 马学真

doi:10.3969/j.issn.1000-8179.2012.10.023

立体定向放疗联合全脑放疗和福莫司汀治疗脑转移瘤的临床观察

Clinical Observation of Stereotactic Radiosurgery Combined with Whole Brain Radiotherapy and Fotemustine for Brain Metastases

摘要

摘要:
目的观察立体定向放疗联合全脑放疗和福莫司汀治疗脑转移瘤的近期疗效、颅内无进展生存时间以及不良反应。
方法 72例脑转移瘤患者, 随机分为36例立体定向放疗联合全脑放疗组(SRS联合组)和36例单纯全脑放疗组(WBRT组)。两组均在放疗的第1、8、15天静脉给予福莫司汀(2 mg/kg)。
结果 SRS联合组和WBRT组的有效率分别是91.7%和72.2%, 差异有统计学意义(χ²=4.600, P < 0.05), 两组中位颅内无进展生存时间分别为9.0个月和7.0个月, 差异有统计学意义(χ²=4.159, P < 0.05)。SRS联合组的中枢神经系统反应较WBRT组轻, 两组差异有统计学意义。两组的主要不良反应为骨髓抑制, 但大部分患者能耐受。
结论立体定向放疗联合全脑放疗可提高脑转移瘤的缓解率及颅内无进展生存时间。立体定向放疗联合全脑放疗和福莫司汀治疗脑转移瘤疗效高, 不良反应可以耐受, 是治疗脑转移瘤的较好选择。

Abstract:
Objective This work aims to investigate the short-term effect, toxicity, and disease-free survival time of stereotactic radiosurgery(SRS) combined with whole brain radiation therapy(WBRT) and fotemustine in brain metastases.
Methods A total of 72 cases with brain metastases were randomized into the SRS and simple WBRT groups.Fotemustine(2 mg/kg) was administered intravenously on days 1, 8, and 15.
Results The overall response rate was significantly higher in the SRS group(91.7%) than in the WBRT group(72.2%;P < 0.05).The median disease-free survival time to cerebral progression in the SRS and WBRT groups were 9.0 and 7.0 months, respectively(P < 0.05).The central nervous system toxicity was milder in the SRS group than that in the WBRT group.Systemic toxicity of the two groups was primarily hematologic toxicity that was tolerated by most patients.
Conclusion s: SRS with WBRT and fotemustine is a feasible therapeutic option for patients with brain metastases.This therapy can improve the clinical response rate and median survival time to cerebral progression of the disease.

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