脑转移对吉非替尼治疗有效NSCLC患者生存期和生活质量的影响被引量：3

The effect of brain metastasis on survival and quality of life of patients with effective treatment of gefitinib

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摘要目的观察吉非替尼治疗非小细胞肺癌(NSCLC)有效超过6个月后,脑转移对患者生存期及生活质量的影响。方法依据核磁共振(MRI)判断有无脑转移,伴有脑转移患者为试验组,无脑转移患者为对照组。试验组给予吉非替尼250 mg/d治疗加或不加颅脑放疗,对照组给予吉非替尼250mg/d治疗。比较两组的总生存期(OS)、无进展生存期(PFS)、生活质量(QOL)和认知障碍。结果试验组纳入27例,其中22例在吉非替尼治疗前、5例在吉非替尼治疗后出现脑转移,对照组61例。试验组及对照组的OS[(22.50±10.50)个月vs(21.95±12.75)个月]、PFS[(17.24±10.76)个月vs(16.15±11.78)个月]比较,差异无统计学意义。试验组和对照组患者1、2、3年生存率分别为85.0%vs82.6%、35.0%vs 39.1%和15.0%vs 10.9%,差异均无统计学意义。治疗过程中出现脑转移患者行为状态评分(KPS评分)下降不明显。对照组和试验组分别有2例(3.3%)、9例(33.3%)出现认知障碍。结论在肺部病灶能被吉非替尼控制的背景下,脑转移不是影响患者后续生存期及生活质量的主要因素;吉非替尼治疗NSCLC过程中出现脑转移不宜简单地视为"病情进展"而更换治疗方案,原药继续治疗配合颅脑放疗仍然有效;脑转移患者的认知障碍值得重视。 Objective To observe the effect of brain metastasis on survival and quality of life of the patients whose non-small cell lung cancer（NSCLC） have been effectively treated by gefitinib for over six months. Methods Brain metastasis was identified based on MRI. The patients with brain metastasis was taken as experiment group, and those without brain metastasis as control. The experiment group was treated with gefitinib with or without brain radiotherapy, while the control group received gefitinib only. The two groups were compared from such aspects as overall survival （OS）, progression-free survival （PFS）, the quality of life（QOL）, and cognitive disorder. Results There were 27 cases in the experiment group （22 of them had brain metastasis before gefitinib treatment and 5 of them had brain metastasis after gefitinib） and 61 cases in the control group, there was no statistically significant difference showed in the OS E （ 22.50 ± 10.50） months vs （21.95 ± 12. 75 ） months ] and PFS [ （ 17.24 ± 10.76） months vs （16. 15 ± 11.78） months] of the two groups. Two groups＇1-,3-,5- years survival rate were 85% vs 82. 6% ,35% vs 39. 1%, and 15.0% vs 10. 9%, respectively,which showed no statistical significance. Karnofsky performance status did not decrease significantly when brain metastasis was detected during the treatment procedure. Two cases （3.3%） in the control group was noted, but not in 9 cases （33.3%） in the experiment group. Conclusion As regard to patients whose pulmonary lesion could be controlled by gefitinib, brain metastasis is not the main factor affecting the following lives time and the quality of lives of the patients. During the treatment procedure of NSCLC with gefitinib, the brain metastases should not be simply regarded as the disease progression to change the treatment plan, continuous treatment by gefitinib in combination with brain radiotherapy was still effective. Attention should be paid to the cognitive disorder of the patients with brain metastases.

作者陈婷婷陈振东王年飞李娜李飞

机构地区安徽医科大学第二附属医院肿瘤中心安徽省立新安医院肿瘤科

出处《安徽医科大学学报》 CAS 北大核心 2013年第6期656-659,共4页 Acta Universitatis Medicinalis Anhui

关键词非小细胞肺癌脑转移吉非替尼总生存期生活质量认知障碍 non-small cell lung cancer brain metastasis gefitinib overall survival quality of life cognitive disorder

分类号 R734.2 [医药卫生—肿瘤]

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参考文献13

1彭丹涛(编译),朱瑞(编译),许贤豪(编译).《精神障碍诊断与统计手册》-5神经认知障碍诊断标准（草案）[J].中华老年医学杂志,2011,30(1):7-12. 被引量：55
2Sajama C, Lorenzoni J, Tagle P. Diagnosis and treatment of brainmetastasis[J]. Rev Med Chil,2008,136(10) :1321 -6.
3Robinet G,Thomas P, Breton J L,et al. Results of a phase ISstudy of early versus delayed whole brain radiotherapy with concur-rent cisplatin and vinorelbine combination in inoperable brain me-tastasis of non - small-cell lung cancer : Groupe Francais de Pneu-mo-Cancerologie ( GFPC) Protocol 95 - 1 [ J]. Ann Oncol,2001,12(1) :59 -67.
4Cortes J, Rodriguez J, Aramendia J M, et al. Front-line paclitax-el/cisplatin-based chemotherapy in brain metastases from non-small-cell lung cancer[ J]. Oncology,2003 ,64(1 ) :28 - 35.
5Bearz A, Garassino I,Tiseo M, et al. Activity of pemetrexed onbrain metastases from non-small cell lung cancer[ J]. Lung Canc-er,2010,68(2) :264 -8.
6Kim J E,Lee D H,Choi Y,et al. Epidermal growth factor recep-tor tyrosine kinase inhibitors as a first-line therapy for never-smok-ers with adenocarcinoma of the lung having asymptomatic synchro-nous brain metastasis[ J]. Lung Cancer,2009 ,65 (3 ) :351 -4.
7白皓,韩宝惠.厄洛替尼治疗非小细胞肺癌脑转移初步分析[J].中国肺癌杂志,2009,12(12):1271-1275. 被引量：12
8Carolan H, Sun A Y,Bezjak A, et al. Does the incidence andoutcome of brain metastases in locally advanced non-small cell lungcancer justify prophylactic cranial irradiation or early detection.[J]. Lung Cancer,2005,49(1) ;109 -15.
9Wu J Y,Shih J Y, Yang C H, et al. Second-line treatments afterfirst-line gefitinib therapy in advanced nonsmall cell lung cancer[J]. Int J Cancer,2010,126(l) :247 -55.
10白皓,韩宝惠.吉非替尼治疗50例非小细胞肺癌脑转移的临床分析[J].中国癌症杂志,2010,20(2):134-139. 被引量：38

二级参考文献51

1郁毅刚,汪求精,蔡颖谦,姚谦明,丁涟沭,何旭英.奥拉西坦治疗中、重型脑损伤认知障碍临床研究[J].中华神经外科疾病研究杂志,2005,4(4):368-369. 被引量：6
2王忠良,吴国伟,万红建,刘军,毛世文.天麻素针治疗中风认知障碍临床观察[J].浙江中西医结合杂志,2005,15(11):675-676. 被引量：11
3王燕,王颖,王彬,王子平,张湘茹,储大同,孙燕.吉非替尼治疗非小细胞肺癌脑转移的初步结果[J].中国肺癌杂志,2006,9(5):447-451. 被引量：33
4Jemal A, Murray T, Samuels A, et al. Cancer statistics, 2003. CA Cancer J Clin, 2003, 53 (1): 5-26.
5Wen PY, Black PM, Loeffler JS. Treatment of metastatic cancer. Devita VTJr, HeUman S, Rosenberg SA. Cancer: Principles and Practice of Oncology. 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2001: 2655-2670.
6Noel G, Medioni J, Valery CA, et al. Three irradiation treatment options including radiosurgery for brain metastases from primary lung cancer. Lung Cancer, 2003, 41(3): 333-343.
7Kepka L, Cieslak E, Bujko K, et al. Results of the whole-brain radiotherapy for patients with brain metastases from lung cancer: the RTOG RPA intraclasses analysis. Acta Oncol, 2005, 44(4): 389-398.
8Kong DS, Lee JI, Nam DH, et al. Prognosis of non-small cell lung cancer with synchronous brain metastases treated with gamma knife radiosurgery Korean Med Sci, 2006, 21 (3): 527-532.
9Lai CSL, Boshoff C, Falzon M, et al. Complete response to erlotinib treatment in brain metastases from recurrent NSCLC. Thorax, 2006. 61 (1): 91.
10Popat S, Hughes S, Papadopoulos P, et al. Recurrent responses to non-small cell lung cancer brain metastases with erlotinib. Lung Cancer, 2007, 56(1): 135-137.