| Objective:To evaluate the effectiveness and safety of temozolomide and whole brain radiotherapy in the treatment of the patients with brain metastases from non-small cell lung cancer,and investigate the correlation between the serum tumor marker of patients with brain metastases from non-small cell lung cancer and clinical pathology,pathological pattern,short-term curative effect and prognosis.Methods:80 cases patients with brain metastases from non-small cell lung cancer were collected from January 2016 to December 2017 in our hospital conducted prospective study,including men with 57 cases,women with 23 cases,the ratio of male to female was 2.48:1,age with 47-72 years,the average age with(58.38±14.62)years.The staging criteria of tumor according to American Joint Committee on Cancer of 2009 version,including 43 cases patients with stage ? and ?,37 cases patients with stage ?a,the pathological type including 16 cases patients with adenocarcinoma of lung,64 cases patients with squamous cell lung carcinoma.When cancer patients with pathological types of lung glands were enrolled,most of them refused to detect EGFR and other genes for their own economic and other reasons.All patients in the study according to the random number method divided into observation group(40 cases)and control group(40 cases),the observation group was given temozolomide combined with whole brain radiotherapy,oral temozolomide was administered simultaneously with whole brain radiotherapy,the control group was given whole brain radiotherapy.Compared with the recent clinical treatment response rate and disease control rate,follow-up was 18 months and median follow-up was 9 months,and calculate the median survival time and median recurrence time by Kaplan-Meier,and find the prognosis risk factors of the patients with brain metastases from non-small cell lung cancer by the multivariate COX regression analysis.To evaluate the clinicopathology,tumor staging of the patients with brain metastases from non-small cell lung cancer and the serum level of cytokeratin 19 fragment,squamous cell carcinoma antigen,squamous cell carcinoma antigen and carcino embryonic antigen,and investigate the clinical therapeutic effect and clinical prognosis and the level of tumor marker of the serum.Results:1.80 cases patients with brain metastases from non-small cell lung cancer including 53 cases patients with men,68 cases patients combined with brain metastasis symptoms,80 cases patients with number of brain metastases>3 cm,59 cases patients with smoking history,2 cases patients with brainstem transfer,37 cases patients of the ages>60;2.Compared with the gender,age,tumor type,tumor staging tumor marker Symptoms of brain metastasis and brainstem transfer of the two groups,the differences were not statistically significant(P>0.05);3.The serum SCC-Ag level in patients with lung squamous cell carcinoma and non-small cell lung cancer brain metastasis was significantly higher than that in lung adenocarcinoma patients(P<0.05).The serum of patients with lung adenocarcinoma non-small cell lung cancer brain metastases The levels of NSE,CYFRA21-1,and CEA were higher than those of lung squamous cell carcinoma,respectively,and the difference was statistically significant(P<0.05).The serum NSE and CYFRA21-1 of patients with non-small cell lung cancer brain metastases at initial stage III+IV stage.The levels of CEA and SCC-Ag were significantly higher than those of newly diagnosed stage I+II,and the difference was statistically significant(P<0.05).There was no significant difference in gender(P>0.05).4.Compared with the complications of myelosuppression,nausea,vomiting and headache of the two groups,the difference was not statistically significant(P>0.05);5.The clinical treatment efficiency and disease control rate of the observation group respectively is 85.00%(34/40)and 95.00%(38/40),the clinical treatment efficiency and disease control rate of the control group respectively is 65.00%(26/40)and 80.00%(32/40),the difference was statistically significant(P<0.05);6.Compared with the control group,the median survival time and median recurrence time of the observation group both significantly prolong(9.62 months vs 6.15 months,6.34 months vs 4.24 months),the difference was statistically significant(P<0.05);7.The i-PFS time of the observation group was 6.34 months,95%CI was 5.31-7.33;the i-PFS time of the control group was 4.24 months,95%CI was 3.23-5.19;the OS time of the observation group was 9.62.Months,95%CI was 8.15-1.101;the control group had an OS time of 6.15 months,95%CI was 5.94-6.33;8.The multivariate COX regression analysis showed that KPS score,the brainstem transfer and the tumor type,lung adenocarcinoma is the risk factor of poor prognosis of the patients with brain metastases from non-small cell lung cancer;9.Compared with before treatment,the levels of NSE,CYFRA21-1,SCC-Ag and CEA in the PR and CR treatment grades after treatment were significantly decreased,and the difference was statistically significant(P<0.05).10.The progression-free survival and overall survival of the patients with brain metastases from non-small cell lung cancer with NSE?16.3 ng/mL both significantly shortened than that patients with NSE<16.3 ng/mL;The progression-free survival and overall survival of the patients with brain metastases from non-small cell lung cancer with CYFRA21-1?3.3 ng/mL both significantly shortened than that patients with CYFRA21-1<3.3 ng/mL;The progression-free survival and overall survival of the patients with brain metastases from non-small cell lung cancer with CEA?4.7 ng/mL both significantly shortened than that patients with CEA<4.7 ng/mL;The progression-free survival and overall survival of the patients with brain metastases from non-small cell lung cancer with SCC-Ag?1.5 ng/mL both significantly shortened than that patients with SCC-Ag<1.5 ng/mL,the difference was statistically significant(P<0.05).Conclusion:Temozolomide and whole brain radiotherapy in the treatment of non-small cell lung cancer with brain metastases has good recent clinical curative effect and long-term clinical curative effect,and the incidence of adverse reactions is low,KPS score,brainstem metastasis and tumor type TNM staging for lung adenocarcinoma is poor prognosis in NSCLC patients with brain metastases of risk factors,there is a certain relationship between the serum tumor markers NSE CYFRA21-1 the CEA and SCC-Ag and non-small cell lung cancer patients with brain metastatic tumor pathological staging of tumor types,clinical treatment effect and prognosis. |
PDF Full Text Request