| Background and objective：Lung cancer is a serious threat to human healthcommon malignant tumors, small cell lung cancer (SCLC) in lung cancer proportion ofabout20%to25%, a high degree of malignancy, easy early disseminated,60%ofpatients at the time of diagnosis extrapulmonary metastases and poor prognosis, the5-year survival rate is less than20%. Brain metastases was20to40%, the longersurvival time, higher incidence of central nervous system metastasis, survival more than5years up to80%. Brain metastasis of lung cancer to become one of the importantcauses of lung cancer deaths.The purpose of this study is to explore the early applicationof carmustine or prophylactic cranial irradiation of brain metastases of small cell lungcancer in remission role in the prevention and prognosis analysis.Method：Collection of Liaoning Provincial Tumor Hospital from January2003toDecember2011the Court by histopathology confirmed the first-line treatment efficacyevaluation of CR or PR in patients with small cell lung cancer,268cases.The patientswere divided into the PCI group, carmustine group and without any prevention of brainmetastases treatment group, application carmustine patients in34cases, the use ofprophylactic cranial irradiation in patients with26cases, the control group was208cases.The three groups were compared brain metastasis rate,1-year,2-year,5-yearsurvival, progression-free survival, overall survival and adverse reactions to analyze theindependent risk factors affecting the survival time of patients.Result：Three groups the incidence of brain metastases were BCNU group of6patients (17.6%),4cases (15.4%) of the PCI group, the control group of70patients(33.7%), the difference was statistically significant (P=0.04<0.05), BCNU brainmetastases were lower than the control group and the PCI group.Three groups1a,2a and5a survival rates were BCNU group,12(50.0%),9(37.5%),3(12.5%); PCI group,15(68.2%),6(27.3%),1(4.5%);87(81.3%) of the control group,18(16.8%),2(1.9%), three groups of brain metastasis rate difference was statistically significant (P=0.01<0.05).Three groups of progression-free survival compared, the difference wasstatistically significant (P=0.01<0.05), the difference between the three groupsprogression-free survival of at least two groups.Overall survival compared, thedifference was statistically significant (P=0.00<0.05), and that the difference betweenthe overall survival time is at least at least two groups.3myeloid side effects differencewas statistically significant (P=0.04<0.05).BCNU and PCI groups of three degrees,four degrees incidence of side effects was significantly higher.KPS score, drinkinghistory, supraclavicular lymph node metastasis and pleural metastasis risk factors ofoverall survival time, the highest risk of pleural metastasis (RR=2.086), and the rest ofthe drinking history (RR=1.629), supraclavicular lymph node metastasis (RR=1.503),KPS score (RR=1.433);Surgery (RR=0.574), number of chemotherapy cycles (RR=0.536) and the first-line treatment is a protective factor for overall survival.Brainmetastases (RR=2.305), stage (RR=2.112), pulmonary metastasis (RR=2.056), lungmetastasis (RR=1.776), history of alcohol consumption (RR=1.749), liver metastases(RR=1.733), PS Rating (RR=1.677), TNM stage (RR=1.138) are risk factors forprogression-free survival;The number of cycles of chemotherapy (RR=0.545) offirst-line therapy is a protective factor for progression-free survival.Conclusion：Prophylactic cranial irradiation and application of carmustine canreduce the incidence of remission stage small cell lung cancer brain metastases.Prophylactic cranial irradiation meaningful extension of disease progression and overallsurvival time, the carmustine group in this respect there was no significant benefit. |
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