后程三维适形放疗联合紫杉醇化疗治疗老年人乳腺癌伴脑转移癌的临床观察

目的 观察后程三维适形放疗(3D-CRT)联合紫杉醇同步化疗治疗老年乳腺癌伴脑转移癌患者的疗效及不良反应.方法 50例患者随机分为观察组(放疗加化疗组,26例)和对照组(单纯放疗组,24例).两组前程全脑均行普通二维放疗,在全脑照射总剂量(DT)30～40 Gy后,后程缩野对脑转移癌局部病灶行3D-CRT,每次2 Gy,每周5次,加量DT 10～24 Gy,至DT 50～64Gy.观察组在放疗2～4周期间给予紫杉醇65～85 mg/m2,静脉滴注第1、8天,同步化疗,然后继续用紫杉醇单药化疗2～4个周期(紫杉醇65～85 mg/m2,第1、8、15天静脉滴注);28 d为1周期,治疗2月后,观察两组近期疗效、不良反应及评价生活质量;随访2年评价客观疗效和生存率.结果 观察组有效率76.9%,高于对照组45.8%,两组比较有统计学差异(x2=5.120,P＜0.05).Karnofsky计分提高+稳定者观察组80.8%、对照组54.2%,观察组生活质量改善高于对照组(x2=4.059,P＜0.05);与对照组相比,观察组白细胞下降,差异有统计学意义;血小板减少、恶心呕吐、肝功能异常等不良反应发生率稍高于对照组,差异无统计学意义.两组2年生存率比较差异有统计学意义(x2=4.7260,P＜0.05).结论 后程3D-CRT联合紫杉醇单药化疗治疗老年乳腺癌伴脑转移癌患者可提高远、近期疗效,不良反应虽有所增加,但患者能耐受,值得临床上进一步推广应用.

Abstract：

Objective To evaluate the efficacy and adverse reaction of three-dimensional conformal radiation therapy (3D-CRT) combined with chemotherapy of paclitaxel in treatment of brain metastases from breast cancer in the elderly.Methods The 50 patients were randomly divided into observation group (n=26,radiation combined with chemotherapy) and control group (n= 24,simple radiation).In the early stage,both groups received common two-dimesional conformal radiation therapy.The total dose (DT) of whole brain irradiation was 30-40 Gy.In the later stage,the reduced field for the local lesion of brain metastases would be altered to 3D-CRT for the post period with 2 Gy 5 times a week.DT was added from 10-24 Gy up to total DT of 50-64 Gy.The patients were given paclitaxel 65-85 mg/m2 by intravenous drip at 1st and 8th day with synchronization of 2-4 weeks,having paclitaxel chemotherapy of 2-4 circle,28 days a circle.After 2 month treatment,the efficacy and adverse effects of the two groups were observed.follow up for 2 years,the long-term efficacy and survival rate were evaluated.Results The effective rate was 76.9% in observation group and 45.8% in control group,respectively (x2 =5.120,P＜0.05) and the KPS score was 80.8% and 54.2%,respectively.The quality of life was improved in observation group versus control group (x2 =4.059,P＜0.05).Compared with control group,hypoleukemia was significant in observation group (P＜0.05).The complications such as nausea and vomiting,hepatic dysfunction were more in observation group than in control group,but there was no statistical significance between two groups.There was statistic ally significant difference in 2-year survival rate between two groups (x2= 4.7260,P＜0.05).Conclusions The 3D-CRT combined with paclitaxel chemotherapy is a prefered choice for locally advanced brain metastases from breast cancer.More side effects and adverse reaction are observed in observation group.However,all the patients could tolerate them.It is worthy of popularization and application.

Clinical therapeutic effect of three-dimensional conformal radiation therapy combined with chemotherapy of paclitaxel on brain metastases from breast cancer in the elderly

Objective To evaluate the efficacy and adverse reaction of three-dimensional conformal radiation therapy (3D-CRT) combined with chemotherapy of paclitaxel in treatment of brain metastases from breast cancer in the elderly.Methods The 50 patients were randomly divided into observation group (n=26,radiation combined with chemotherapy) and control group (n= 24,simple radiation).In the early stage,both groups received common two-dimesional conformal radiation therapy.The total dose (DT) of whole brain irradiation was 30-40 Gy.In the later stage,the reduced field for the local lesion of brain metastases would be altered to 3D-CRT for the post period with 2 Gy 5 times a week.DT was added from 10-24 Gy up to total DT of 50-64 Gy.The patients were given paclitaxel 65-85 mg/m2 by intravenous drip at 1st and 8th day with synchronization of 2-4 weeks,having paclitaxel chemotherapy of 2-4 circle,28 days a circle.After 2 month treatment,the efficacy and adverse effects of the two groups were observed.follow up for 2 years,the long-term efficacy and survival rate were evaluated.Results The effective rate was 76.9% in observation group and 45.8% in control group,respectively (x2 =5.120,P＜0.05) and the KPS score was 80.8% and 54.2%,respectively.The quality of life was improved in observation group versus control group (x2 =4.059,P＜0.05).Compared with control group,hypoleukemia was significant in observation group (P＜0.05).The complications such as nausea and vomiting,hepatic dysfunction were more in observation group than in control group,but there was no statistical significance between two groups.There was statistic ally significant difference in 2-year survival rate between two groups (x2= 4.7260,P＜0.05).Conclusions The 3D-CRT combined with paclitaxel chemotherapy is a prefered choice for locally advanced brain metastases from breast cancer.More side effects and adverse reaction are observed in observation group.However,all the patients could tolerate them.It is worthy of popularization and application.