伽玛刀联合替莫唑胺同步放化疗对脑转移瘤的疗效及安全性研究
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摘要
目的探讨伽玛刀联合替莫唑胺同步放化疗对脑转移瘤的疗效及安全性。方法将内蒙古医科大学附属医院120例确诊为脑转移瘤患者作为研究对象,分为对照组和联合组,对照组给予伽玛刀治疗,联合组在对照组治疗基础上应用替莫唑胺进行联合治疗。比较2组患者临床疗效及不良反应的发生情况。结果联合组治疗总有效率为88.33%,较对照组的58.33%显著升高(P <0.01)。随访2年,2组患者均获随访,其中联合组总生存率(63.33%)较对照组(38.33%)明显升高(P <0.05),生存时间[(17.97±3.34)个月]较对照组[(12.53±2.15)个月]明显延长(P<0.01)。2组恶心呕吐、头痛、血小板减少、白细胞减少和急性脑损伤等不良反应发生率差异均无统计学意义(P均>0.05)。结论伽玛刀联合替莫唑胺可有效改善脑转移瘤患者的近远期疗效,亦不会加剧不良反应的发生,因此具有良好的安全性,且可有效延长患者的生存时间,提高患者的生存质量,可作为一种有效且安全的治疗方案,患者具有良好的耐受性。
Objective To analyze the efficacy and safety of gamma knife combined with temozolomide concurrent chemoradiotherapy for brain metastases.Methods 120 cases of brain metastases in our hospital were treated as the study objects,and they were divided into the control group and the combined group.The control group received gamma knife treatment and the combined group was treated with temozolomide on the basis of the control group.The clinical efficacy and adverse reactions of the two groups were compared.Results The overall effective rate of the combined group was 88.33%,which was significantly increased comparison of the control group(58.33%,P <0.01).After 2years of follow-up,the overall survival rate of the combined group(63.33%)was significantly increased compare to the control group(38.33%,P <0.05),and the survival time[(17.97±3.34)months]was significantly longer than that of the control group[(12.53±2.15)months](P <0.01).There was no significant difference between two groups in the incidence rate of nausea and vomiting,headache,thrombocytopenia,leukocyte reduction,acute brain injury and other adverse reactions(P >0.05).Conclusion Gamma knife combined with temozolomide can effectively improve the near and long term effect of brain metastases,and will not aggravate the occurrence of adverse reactions.Therefore,it possesses the advantage of effectively prolong the survival time and improve the quality of life,safety and well tolerance in patients.
Objective To analyze the efficacy and safety of gamma knife combined with temozolomide concurrent chemoradiotherapy for brain metastases.Methods 120 cases of brain metastases in our hospital were treated as the study objects,and they were divided into the control group and the combined group.The control group received gamma knife treatment and the combined group was treated with temozolomide on the basis of the control group.The clinical efficacy and adverse reactions of the two groups were compared.Results The overall effective rate of the combined group was 88.33%,which was significantly increased comparison of the control group(58.33%,P <0.01).After 2years of follow-up,the overall survival rate of the combined group(63.33%)was significantly increased compare to the control group(38.33%,P <0.05),and the survival time[(17.97±3.34)months]was significantly longer than that of the control group[(12.53±2.15)months](P <0.01).There was no significant difference between two groups in the incidence rate of nausea and vomiting,headache,thrombocytopenia,leukocyte reduction,acute brain injury and other adverse reactions(P >0.05).Conclusion Gamma knife combined with temozolomide can effectively improve the near and long term effect of brain metastases,and will not aggravate the occurrence of adverse reactions.Therefore,it possesses the advantage of effectively prolong the survival time and improve the quality of life,safety and well tolerance in patients.
引文
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[5]王多明,王若峥,刘浩,等.X线立体定向放射治疗脑转移瘤48例疗效观察[J].新疆医科大学学报,2005,28(8):711-713.
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[9]张旭东,张世强,王雪峰,等.伽玛刀联合尼莫司汀治疗脑转移瘤的临床疗效观察[J].肿瘤学杂志,2014,20(12):1049-1051.
[10]魏凯,张起,胡金龙,等.替莫唑胺联合放射治疗脑转移瘤临床观察[J].中国实用神经疾病杂志,2018,21(11):1222-1227.
[11]王嘉嘉,梁军潮,伍犹梁,等.伽玛刀联合替莫唑胺治疗脑转移瘤的假性进展1例[J].中国微侵袭神经外科杂志,2015,20(6):279-280.
[12]AHMED KA,STALLWORTH DG,KIM Y,et al.Clinical outcomes of melanoma brain metastases treated with stereotactic radiation and anti-PD-1therapy[J].Ann Oncol,2015,27(3):434-441.
[13]马玉超,肖建平,毕楠,等.大分割放疗联合替莫唑胺治疗大体积脑转移瘤的前瞻性临床研究[J].中华放射肿瘤学杂志,2016,25(4):320-326.
[14]马玉超,肖建平,毕楠,等.FSRT联合替莫唑胺治疗大体积脑转移瘤的对照研究[J].中华放射肿瘤学杂志,2018,27(4):348-353.
[15]朱礼.老年脑转移瘤患者再次放疗联合替莫唑胺化疗疗效分析[J].临床军医杂志,2017,45(3):272-274.
[2]刘艳,张越,黎星,等.对比分析单发脑转移瘤与高级别星形细胞瘤MRI征象的鉴别要点[J].新疆医科大学学报,2009,32(7):949-951.
[3]武智刚,王千,吴铁鹰,等.旋转式头部伽玛刀治疗脑转移瘤171例临床分析[J].中华神经外科疾病研究杂志,2013,12(6):540-542.
[4]GAUDY-MARQUESTE C,CARRON R,DELSANTI C,et al.On demand gamma-knife strategy can be safely combined with BRAF inhibitors for the treatment of melanoma brain metastases[J].Ann Oncol,2014,25(10):2086-2091.
[5]王多明,王若峥,刘浩,等.X线立体定向放射治疗脑转移瘤48例疗效观察[J].新疆医科大学学报,2005,28(8):711-713.
[6]SHIN SM,COOPER BT,CHACHOUA A,et al.Survival but not brain metastasis response relates to lung cancer mutation status after radiosurgery[J].J Neurooncol,2016,126(3):483-491.
[7]THOMAS EM,POPPLE RA,MARKERT JM,et al.In reply:Volumetric arc therapy(RapidArc)vs Gamma knife radiosurgery for multiple brain metastases:Not only a dosimetric issue[J].Neurosurgery,2015,77(2):E311-E311.
[8]NEAL MT,CHAN MD,LUCAS Jr JT,et al.Predictors of survival,neurologic death,local failure,and distant failure after gamma knife radiosurgery for melanoma brain metastases[J].World Neurosurg,2014,82(6):1250-1255.
[9]张旭东,张世强,王雪峰,等.伽玛刀联合尼莫司汀治疗脑转移瘤的临床疗效观察[J].肿瘤学杂志,2014,20(12):1049-1051.
[10]魏凯,张起,胡金龙,等.替莫唑胺联合放射治疗脑转移瘤临床观察[J].中国实用神经疾病杂志,2018,21(11):1222-1227.
[11]王嘉嘉,梁军潮,伍犹梁,等.伽玛刀联合替莫唑胺治疗脑转移瘤的假性进展1例[J].中国微侵袭神经外科杂志,2015,20(6):279-280.
[12]AHMED KA,STALLWORTH DG,KIM Y,et al.Clinical outcomes of melanoma brain metastases treated with stereotactic radiation and anti-PD-1therapy[J].Ann Oncol,2015,27(3):434-441.
[13]马玉超,肖建平,毕楠,等.大分割放疗联合替莫唑胺治疗大体积脑转移瘤的前瞻性临床研究[J].中华放射肿瘤学杂志,2016,25(4):320-326.
[14]马玉超,肖建平,毕楠,等.FSRT联合替莫唑胺治疗大体积脑转移瘤的对照研究[J].中华放射肿瘤学杂志,2018,27(4):348-353.
[15]朱礼.老年脑转移瘤患者再次放疗联合替莫唑胺化疗疗效分析[J].临床军医杂志,2017,45(3):272-274.