COAPC方案联合脑部放射治疗非小细胞肺癌脑转移

背景与目的：放射治疗具有治疗脑转移癌的主要手段。而到目前为止化疗与放疗联合治疗脑转移癌的研究较少,本研究旨在观察COAPC方案化疗与脑部放射同时治疗非小细胞肺癌（non-small cell lung cancer,NSCLC)脑转移患者疗效,不良反应及生存率。方法：45例NSCLC脑转移患者接受COAPC方案化疗,环磷酰胺0．3g/m^2第1天静推,长春新碱1．4mg/m^2第1天静推,阿霉素50mg/m^2第1天静推,顺铂20mg/m^2第1－5天静滴,司莫司汀80mg/m2第1天口服,每3－4周为1疗程,脑部放射治疗于化疗第1疗程的第6天开始,每次2Gy,每天1次,每周5天,脑转移灶1－3个者,全脑放疗40Gy后,缩野放疗至总量60Gy,脑转移灶＞3个者,全脑放疗至总量40Gy.结果：治疗后80％患者神经系统症状改善,对脑转移灶的客观有效率为64．4％,对肺原发灶的有效率为40％,治疗的主要不良反应为骨髓抑制(Ⅲ-Ⅳ度占35％）,中位生存期10个月,1年生存率44．1％,5年生存率6．7％,单纯脑转移患者的中位生存期14个月,高于多发远处转移患者的9个月（P＝0．012）。结论：化疗联合脑部放射治疗NSCLC脑转移患者有效率与生存率较高,且患者耐受性较好。

Whole-brain radiotherapy combined with COAPC regimen in patients with non-small cell lung cancer

BACKGROUND & OBJECTIVE: The main treatment strategy of cancer patients with brain metastases was irradiation; while so far there were few researches concerning chemotherapy combined with radiotherapy for these patients. This study was designed to observe the therapeutic effect, toxicity, and survival of concurrent whole-brain radiotherapy (WBRT) combined chemotherapy with COAPC regimen in non-small cell lung cancer (NSCLC) patients with brain metastases. METHODS: A total of 45 NSCLC patients with brain metastasis received a course of COAPC regimen cyclophosphamide 0.3 mg/m(2) i.v. d(1), vincristine 1.4 mg/m(2) i.v. d(1), doxorubicin 50 mg/m(2) i.v. d(1), cisplatin 20 mg/m(2) i.v. d(1-5), semustine 80 mg/m(2) PO d(1)] every 3-4 weeks. Whole-brain radiotherapy was administered on day 6 of the first course of chemotherapy using (60)Co at a dose of 2 Gy given in 5 fractions per week. Patients with brain lesions of 1-3 received WBRT at a dose of 40 Gy and then small field to a total dose of 60 Gy. Patients with brain lesions of more than 3 received WBRT at a total dose of 40 Gy. RESULTS: The treatment improved neurological symptoms in 80% of the patients. The response rates to brain lesions and primary lesions were 64.4% and 40.0%, respectively. The median survival time (MST) was 10 months. The 1-year and 5-year survival rates were 44.1% and 6.7%, respectively. The MST in the patients with brain metastasis was only 14 months,which was longer than the MST of 9 months in the patients with other metastasis sites(P=0.012). CONCLUSION: Concurrent WBRT and chemotherapy can be safely preformed for the patients with brain metastasis from NSCLC with a remarkable response rate and encouraging survival duration.