| Objective:To evaluate the clinical efficacy and safety of whole brain +simultaneous integrated boost intensity modulated radiotherapy(SIB-IMRT)combined with concurrent temozolomide in the treatment of brain metastasis of lung cancer.Methods:1 Cases choice:A retrospective analysis was performed on 60 patients with brain metastasis of lung cancer admitted to the chemoradiotherapy center of chengde city central hospital from January 2015 to May 2017,all patients with Clinical,pathological,cytological,imaging examination(B ultrasound,CT or enhanced CT)diagnosed with lung cancer,and brain metastatic carcinoma was diagnosed with craniocerebral enhanced MR or enhanced CT,imaging indexes(enhanced CT)were used to measure the size of brain metastases before and after treatment.2 Groups:Observation group: 30 cases of whole brain +simultaneous integrated boost intensity modulated radiotherapy(SIB-IMRT)combined with concurrent temozolomide were selected as the observation group,including 16 males and 14 females,aged 57.23±10.39 years old.KPS 77.67±4.30 points;There were 18 cases of adenocarcinoma,7 cases of squamous cell carcinoma and 5 cases of small-cell carcinoma.Total length diameter of brain metastasis was > 3cm in 23 cases,?3cm in 7 cases.The number of brain metastasis was ?3 in 6 cases and > in 3 and 24 cases.Malignant pleural effusion was found in 9 cases.Follow-up chemotherapy: 6 patients received GP(gemcitabine + cisplatin)regimen,16 patients received TP(paclitaxel + cisplatin)regimen,5 patients received EP(etoposide + cisplatin)regimen,and 3 patients received no chemotherapy or less than 4 cycles of chemotherapy due to tolerance.Control group: 30 cases of whole brain + concurrent local dose-modulated intensity radiotherapy were selected,including 17 males and 13 females,aged 57.40±9.66 years old.KPS 78.00±4.07 points;There were 17 cases of adenocarcinoma,7 cases of squamous cell carcinoma and 6 cases of small-cell carcinoma.The total length diameter of brain metastasis was > 3cm in 24 cases,?3cm in 6 cases.The number of brain metastasis was ?3 in 8 cases,and >3 in 22 cases.Malignant pleural effusion was found in 8 cases.Follow-up chemotherapy: 6 patients received GP(gemcitabine + cisplatin)regimen,15 patients received TP(paclitaxel + cisplatin)regimen,6 patients received EP(etoposide + cisplatin)regimen,and 3 patients received no chemotherapy or less than 4 cycles of chemotherapy due to tolerance.3 Observation indexes:(1)In terms of brain metastasis,ORR was used as the short-term efficacy evaluation index,and progression-free survival time(PFS)and survival time(OS)were used as the survival observation indexes.Objective response rate(ORR)is the proportion of patients whose tumors have shrunk to a certain amount and maintained for a certain time.According to the RECIST 1.1 version of the solid tumor treatment evaluation criteria,complete response(CR): all target lesions disappeared and maintained for 4 weeks;partial response(PR): the total length of target lesions reduced by ?30%,and maintained for 4 weeks,ORR =(CR + PR)/ total number of cases × 100%.PFS refers to the period of time between the start of treatment and the observation of disease progression or death from any cause.OS is defined as the time between the beginning of treatment and death or the last follow-up.(2)Adverse reactions: the blood system includes neutrophil count,platelet count,hemoglobin count,and digestive system adverse events include nausea and vomiting,and central nervous system adverse events include headaches and cognitive dysfunction.4 Statistical methods:All statistical analysis was completed by SPSS21.0 statistical software.Measurement data were measured by t test,and count data were measured by chi-square test.Kaplan-meier was used to describe the survival process and draw the survival curves.The statistical test level was ? = 0.05,P <0.05 considered that the difference was statistically significant.Results:Short-term objective response rate(ORR): 90.00% in the observation group and 66.67% in the control group,the difference was statistically significant(P=0.038).Median progression-free survival(PFS): 11.0 months in the observation group and 7.7 months in the control group,the difference was statistically significant(P=0.04).Median total survival(OS): 13.8 months in the observation group and 11.4 months in the control group,the difference was statistically significant(P=0.035).Adverse events that occurred in the two groups of patients were mainly manifested in the blood system and digestive system.The observation group: the proportion of decrease in neutrophil absolute count was 60.00%,mainly ?and degrees?,less severe,no need for leukocyte-raising treatment.The rate of platelet decline was 23.33%,which was mainly grade ?,and no platelet elevation treatment was required.The rate of grade ?anemia was 33.33%;the rates of grade ?and ?nausea and vomiting were 76.67% and 23.33%,The proportion of grade and headache was 63.33%,and the proportion ? ?of grade cognitive dysfunction ? was 6.67%.Control group: the proportion of decrease in neutrophil absolute count was 56.67%,which was mainly ?degree,and the degree was mild,and no leukocyte treatment was needed.The rate of platelet decline was 20.00%,which was mainly ?degree,and no platelet elevation treatment was needed.The rate of grade ?anemia was 30.00%;the rate of grade ?and ?nausea and vomiting was 73.33% and 20.00%;the rate of grade ?and ?headache was 60.00%;and the rate of grade ?cognitive dysfunction was 10.00%.No adverse events of grade ?and ?occurred in either group.Nausea,vomiting,and headache were improved after dehydration and intracranial pressure treatment.There was no significant difference in the incidence of adverse events between the two groups of patients(P> 0.05).Conclusion:Whole brain +simultaneous integrated boost intensity modulated radiotherapy(SIB-IMRT)combined with concurrent temozolomide in the treatment of brain metastasis of lung cancer can prolong progression-free survival and overall survival,and the adverse events can be tolerated. |
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