靶向药物治疗肺癌脑转移的效果

李璇　　张国平　　潘汉成

[摘要] 目的 探討靶向药物治疗肺癌脑转移的效果。 方法 将2015年1月至2019年1月在我院肿瘤科治疗的84例EGFR基因突变的肺癌脑转移患者随机分为两组，对照组使用全脑放疗治疗，在此基础上，观察组联合靶向药物吉非替尼治疗，比较两组的近期疗效、不良反应、生存情况、血清因子水平变化。 结果 观察组总体及脑转移灶的治疗有效率、疾病控制率均明显高于对照组，差异有统计学意义（P<0.05）;观察组骨髓抑制、消化道反应发生率低于对照组，而皮疹脱屑发生率高于对照组，差异有统计学意义（P<0.05），两组放射性颅内高压、肝功能损伤不良反应发生率比较，差异无统计学意义（P>0.05）;观察组无疾病进展生存期、总生存期明显长于对照组，1年生存率高于对照组，而远处转移率、局部复发率明显低于对照组，差异有统计学意义（P<0.05）;观察组治疗后MMP-2、MMP-9水平明显低于对照组，差异有统计学意义（P<0.05）。 结论 靶向药物治疗肺癌脑转移的近期效果良好，能增强放疗敏感性，提升杀灭肿瘤效果，从而延长生存时间，抑制肿瘤的复发及转移，且不增加不良反应，具有积极的临床意义。

[关键词] 肺癌脑转移;靶向药物;吉非替尼;生存时间;不良反应

[中图分类号] R734.2          [文献标识码] B          [文章编号] 1673-9701（2021）12-0095-04

Effect of targeted drugs on brain metastasis of lung cancer

LI Xuan   ZHANG Guoping   PAN Hancheng

Department of Oncology， the Third People′s Hospital of Jiujiang City in Jiangxi Province， Jiujiang   332000， China

[Abstract] Objective To explore the effect of targeted drugs on brain metastasis of lung cancer. Methods From January 2015 to January 2019， 84 patients with brain metastasis of lung cancer with EGFR gene mutation were randomly divided into two groups. The control group was treated with whole brain radiotherapy. On this basis， the observation group was treated with gefitinib. The short-term curative effect， adverse reactions， survival conditions and changes of serum factors were compared between the two groups. Results The effective rate and the disease control rate in the observation group were significantly higher than those in the control group，with significant difference（P<0.05）. The incidences of bone marrow suppression and digestive tract reaction in the observation group were lower than those in the control group， but the incidences of skin rash and desquamation were higher than those in the control group，with significant difference（P<0.05）. There was no significant difference in the incidence of adverse reactions such as radiation intracranial hypertension and liver function injury between the two groups （P>0.05）. The disease-free survival time， overall survival time and 1-year survival rate in the observation group were significantly longer than those in the control group， while the distant metastasis rate and local recurrence rate in the observation group were significantly lower than those in the control group，with significant difference（P<0.05）. The levels of MMP-2 and MMP-9 in the observation group were significantly lower than those in the control group after treatment，with significant difference（P<0.05）. Conclusion Targeted drugs have a good short-term effect in the treatment of brain metastasis of lung cancer， which can enhance the sensitivity of radiotherapy and enhance the effect of killing tumor， thus prolonging the survival time and inhibiting the recurrence and metastasis of tumor， without increasing adverse reactions. Thus， it has positive clinical significance.

[Key words] Brain metastasis of lung cancer; Targeted drugs; Gefitinib; Survival time; Adverse reaction

肺癌是临床发病率最高的恶性肿瘤，20%～50%的肺癌患者会发生脑转移，约10%的患者在Ⅰ～Ⅱ期即发生脑转移，Ⅲ期伴局部转移的患者接受放化疗后仍有20%的患者首先出现脑转移[1]。肺癌脑转移提示预后不佳，若未得到有效治疗，大多患者的生存时间不足1个月。但肺癌脑转移的治疗困难，可供选择的治疗方法有限。大多数化疗药物难以通过血脑屏障，化疗的反应率仅为15%～30%，因此化疗并非最佳选择[2]。立体定向放疗已被临床证实是孤立脑转移灶的有效治疗方法，同样也适用于广泛脑转移。目前，全脑放疗已成为肺癌脑转移的标准治疗方案，可延长患者的生存时间至4～6个月，但也有明显缺陷，引发神经认知功能减退、放射性坏死等不良反应，总体疗效无显著提高[3]。……