目的 分析比较替莫唑胺联合伽马刀治疗脑转移癌与单独伽马刀治疗脑转移癌的临床疗效以及不良反应.方法 将确诊脑转移癌病人34例,分成两组:单独伽马刀治疗组(单独组,总剂量35~48 Gy/10~12 f);替莫唑胺联合伽马刀治疗组(联合组,伽马刀治疗期间同时予以口服替莫唑胺150 mg·m-2·d-1,d1~5,放疗结束后继续予以3周期替莫唑胺辅助化疗,方案为150 mg·m-2·d-1,d1~5,28 d为1周期).比较分析两组近期疗效以及不良反应.结果 单独组和联合组治疗近期有效率分别为56.25%和88.89%(P=0.031),1年生存率分别为43.75%和55.56%(P=0.216).两组白细胞、血小板减少发生概率相似(P>0.05).急性脑损伤发生率较高,均以I级损伤为主(联合组为44.44%,单独组为50%).结论 替莫唑胺联合伽马刀治疗脑转移癌是一种安全有效的新型治疗手段,病人耐受性较好.%Objective Tocomparethe clinical efficacy and adverse reactions of two brain metastases treatments:temozolomide combined with Gamma knife treatment and single Gamma knife treatment.Methods 34 patients diagnosed brain metastases were randomly divided into two groups:single gamma knife treatment group(total dose of 35-48 Gy/ 10-12f);temozolomide combined with gamma knife treatment group (During gamma knife treatment,concurrentwithoral temozolomide 150 mg·m-2·d-1,day 1 to 5.After the radiotherapy regimen completed,the patients were continually administered oral temozolomide adjuvant chemotherapy for 3 cycles.The schedule of chemotherapy was temozolomide 150 mg·m-2·d-1,day 1 to 5,28 days as one cycle.).Short-term efficacy and adverse reactions of these two groups were compared.Results The short term effective rates of single radiotherapy group and combination groupwere 56.25% and 88.89% respectively(P=0.031),1 year survival rates were 43.75% and 55.56% respectively(P=0.216).The two groups had similar reduce probability of white blood cells and platelets (P>0.05).High incidence of acute brain injury occured in both groups,most of the injury were grade I damage,(the radiotherapy group was of 50%,while combination group of 44.44%).Conclusions Temozolomide combined with Gamma knife treatment of brain metastaseswas a safe and effective treatment,and patient tolerance was better.
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