Objective Our study aimed to compare the effect of prophylactic cranial irradiation (PCI) or temozolomide (TMZ) in preventing brain metastases from small cell lung cancer and analyze their safety. Methods This trial recruited 52 patients in Chinese PLA General Hospital from Jan 2008 to Dec 2014. All patients were divided into PCI group(26) and TMZ group(26). In PCI group, patients received 25 Gy/10 F prophylactic cranial irradiation after first-line therapy, while in TMZ group patients received oral TMZ (100-150 mg/m2; d1-d5/28 d). One year brain metastases positive rate, cranial-progression-free survival, overall survival and progression free survival were analyzed, and adverse reactions were recorded. Results There were no significant difference between PCI group and TMZ group in 1 year brain metastases positive rate (19.23% vs 30.77%, P > 0.05), cranial-progression-free survival (16 months vs 15 months, P > 0.05), PFS (7 months vs 8 months, P > 0.05) and OS (25 months vs 18 months, P > 0.05). Acute adverse events in PCI group were dizziness and nausea, and some patients had long-term adverse reactions in nervous system. Patients received temozolomide had moderate hematologic toxicities and gastrointestinal adverse reactions, and can be tolerated. Conclusion Temozolomide is well tolerated and as good as traditional PCI in preventing brain metastases. Though temozolomide was inferior to PCI in prolonging OS, there was no statistically significant difference.%目的 比较预防性脑照射与替莫唑胺预防小细胞肺癌放、化疗后脑转移的疗效.方法 收集2008年1月-2014年12月本院初治放化疗后达到缓解(CR或PR)的小细胞肺癌患者52例,分为预防性脑照射(prophylactic cranial irradiation,PCI)组(n=26)、替莫唑胺(temozolomide,TMZ)组(n=26).PCI组在放化疗结束后接受25 Gy/10 F全脑预防性照射治疗,TMZ组在放化疗结束后接受TMZ单药口服维持治疗(第1~5天/28 d).分析两组1年脑转移发生率、颅内无进展生存时间、无进展生存期、总生存期、1年生存率及不良反应的发生情况.结果 PCI组与替莫唑胺组的1年脑转移发生率差异无统计学意义(19.23%vs 30.77%,P>0.05);两组中位颅内无进展生存期差异无统计学意义(16个月vs 15个月,P>0.05);两组中位总生存期差异无统计学意义(25个月vs 18个月,P>0.05).PCI组不良反应主要为头晕、恶心等急性不良反应和远期神经系统不良反应;TMZ组的不良反应主要是血液及胃肠道反应,多为轻、中度.结论 TMZ单药口服预防小细胞肺癌脑转移安全可行.在延长患者总生存方面稍劣于PCI,但差异无统计学意义.
展开▼
