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目的:探讨替莫唑胺联合放疗治疗肺癌、乳腺癌脑转移的临床疗效和安全性。方法:使用替莫唑胺联合放疗治疗肺癌、乳腺癌脑转移患者36例。头部放疗为常规全脑放疗,2Gy/次,5d/周,共4周,总量40 Gy,全脑放疗后,对部分局部病灶三维适形局部加量至50~56Gy。放疗过程中同步化疗,替莫唑胺75mg·m~(-2),Po,放疗当天同时服用。放疗结束后4周开始替莫唑胺治疗,第1周期150mg·m~(-2),po,连续5d,28d一疗程,耐受良好增量至200mg·m~(-2),Po,共化疗6个周期。评价患者疗效与不良反应。结果:36例患者全部完成同步化疗,26例患者完成4个周期化疗,10例患者完成6个周期化疗。放化疗结束后颅內病灶评价:完全缓解11例,部分缓解15例,稳定7例,进展3例,总有效率72.22%(26/36),疾病控制率86.11%(31/36)。主要不良反应为Ⅰ~Ⅱ度的消化道反应,Ⅰ~Ⅱ度骨髓抑制,患者均能耐受。结论:替莫唑胺联合放疗治疗肺癌、乳腺癌脑转移疗效较满意,不良反应可耐受,治疗依从性较好。
Objective: To investigate the clinical efficacy and safety of temozolomide combined with radiotherapy in the treatment of brain metastases of lung cancer and breast cancer. Methods: Temozolomide combined with radiotherapy for lung cancer and breast cancer patients with brain metastases in 36 cases. Head radiotherapy for conventional whole brain radiotherapy, 2Gy / time, 5d / week for 4 weeks, a total of 40 Gy, whole-brain radiotherapy, partial local lesions three-dimensional conformal local dosage to 50 ~ 56Gy. Synchronous chemotherapy during radiotherapy, temozolomide 75mg · m ~ (-2), Po, radiotherapy day to take at the same time. Temozolomide was started 4 weeks after the end of radiotherapy. The first cycle was 150 mg · m -2, po for 5 days and 28 days. The tolerable increment was 200 mg · m -2, Po, total chemotherapy 6 A cycle. Evaluation of patient efficacy and adverse reactions. Results: Thirty-six patients completed synchronous chemotherapy, 26 patients completed 4 cycles of chemotherapy, and 10 patients completed 6 cycles of chemotherapy. Evaluation of intracranial lesions after radiotherapy and chemotherapy: complete remission in 11 cases, partial remission in 15 cases, stable in 7 cases, progression in 3 cases, the total effective rate was 72.22% (26/36), the disease control rate was 86.11% (31/36). The main adverse reactions were grade Ⅰ ~ Ⅱ digestive tract reactions, Ⅰ ~ Ⅱ degree myelosuppression, patients can tolerate. Conclusion: Temozolomide combined with radiotherapy for lung cancer, breast cancer is more satisfied with brain metastases, adverse reactions can be tolerated, the treatment compliance is better.