沙利度胺联合全脑放化疗治疗20例非小细胞肺癌脑转移疗效分析

目的]探讨沙利度胺联合全脑放化疗对晚期非小细胞肺癌脑转移治疗的疗效及毒副作用。方法]20例晚期非小细胞肺癌脑转移患者，接受全脑放疗DT30～36Gy／20～24F，2-2．5周（加速超分割放疗），脑单个病灶患者追加每周DT9～15Gy／6～10F，所有患者从放疗开始均口服沙利度胺200mg／d，直至疾病进展或出现不可耐受的毒副反应。全脑放疗15Gy／10F后根据患者的病理类型和一般状况选择不同的化疗方案。结果]沙利度胺联合全脑放化疗对非小细胞癌脑转移的总有效率（CR＋PR）为70．0％，临床获益率（CR＋PR＋SD）为100％（3例CR，11例PR，6例SD）；口服沙利度胺时间〉6个月者中位生存期与〈6个月者比较差异有统计学意义（14．1个月vs．6．9个月，Х^2=4．615，P〈0．05）；主要毒副反应为轻中度便秘和疲乏，但可耐受。结论]沙利度胺联合全脑放化疗治疗晚期非小细胞肺癌脑转移有明显的疗效．有必要进一步开展随机对照临床研究，以明确抗血管生成药物联合放化疗对脑转移的作用。

Efficacy of Thalidomide Combined with Whole Brain Radio-therapy and Chemotherapy in 20 Cases with Non-small Cell Lung Cancer with Brain Metastasis

Purpose] To investigate therapeutic efficacy and side effect of thalidomide combined with whole brain radiotherapy and chemotherapy for advanced non-small cell lung cancer（NSCLC） patients with brain metastasis. Methods] Twenty advanced NSCLC patients with brain metastasis received whole brain radiotherapy of DT30-36Gy/20-24F, 2-2.5w （accelerated hyperfractionated radiotherapy）. A dose of DT9-15 Gy/6-10F, lw was added to patients with single brain metastatic lesion. All patients received 200mg of thalidomide from beginning of radiotherapy until disease progression or intolerable side effects. Systemic chemotherapy with different chemotherapeutic regimens was applied according to pathological types and general status of patients after whole brain radiotherapy of 15Gy/10F. Resultsl In NSCLC patients with brain metastasis, the overall response rate and clinical benefit rate of thalidomide combined with whole brain radiotherapy and chemotherapy were 70.0% and 100% respectively （CR in 3 patients, PR in 11 patients, and SD in 6 patients）. While thalidomide was applied more than 6 months, the median survival was 14.1 months, which was significantly longer than that less than 6 months. Light to moderate constipation and fatigue were the most common side effects, those were tolerable.Conclusion] Thalidomide combined with radiotherapy for the whole brain and chemotherapy had significant therapeutic effects on NSCLC patients with brain metastasis. It was necessary to conduct further clinical trials to demonstrate the effects of antiangiogenic agents combined radiochemotherapy for NSCLC patients with metastatic brain lesions.