埃克替尼聯合放療治療非小細胞肺癌腦轉移的療效及安全性探討

夏云　王志

[摘要] 目的 探討埃克替尼聯合放療治療非小細胞肺癌（NSCLC）腦轉移的療效及安全性。 方法 選取2014年3月～2016年3月我院收治40例非小細胞肺癌（NSCLC）腦轉移患者，分為觀察組與對照組，每組20例。對照組采用地塞米松及甘露醇脫水治療的同時，對患者行全腦放療；觀察組加以埃克替尼治療，直到毒副反應不能耐受為止。在結束治療之后，對比兩組患者治療效果及安全性。 結果 兩組患者中，最短隨訪時間均為3個月。觀察組有4例患者出現腫瘤進展而停止服藥。在進行治療干預之后，相較于對照組治療總有效率75.00%，觀察組為95.00%較為優異，差異有統計學意義（P<0.05）；轉氨酶升高、骨髓抑制、嘔吐、皮疹、腹瀉，是出現于治療期間的不良反應，且患者經治療后均緩解。 結論 針對非小細胞肺癌（NSCLC）腦轉移患者，采用埃克替尼聯合放療治療，患者毒副反應大多可耐受，近期療效較好，還需進一步觀察對患者長期生存的影響，具有臨床應用價值。

[關鍵詞] 非小細胞肺癌腦轉移；埃克替尼；放療；安全性；治療效果

[中圖分類號] R734.2 [文獻標識碼] B [文章編號] 1673-9701（2017）36-0078-03

[Abstract] Objective To investigate the efficacy and safety of icotinib combined with radiotherapy in the treatment of non-small cell lung cancer （NSLC） brain metastases. Methods From March 2015 to March 2016， 40 patients with brain metastases induced by non-small cell lung cancer （NSLC） who were admitted to our hospital were selected and were divided into observation group and control group， with 20 cases in each group. The control group was given dexamethasone and mannitol for dehydration， and at the same time， the patients were given whole brain radiotherapy. Based on this， the observation group was further given icotinib until the toxic and adverse reactions were not tolerated. After the end of treatment， the efficacy and safety of the two groups were compared. Results In the two groups of patients， the shortest follow-up time was 3 months. 4 patients in the observation group showed tumor progression and thus withdrew from taking medicine. After treatment intervention， compared with the the total effective rate of 75.00% in the control group， the total effective rate was 95.00% in the observation group， which was more excellent. The difference was statistically significant（P<0.05）； increased aminotransferases， myelosuppression， nausea， vomiting， rash， diarrhea were the adverse reactions that occurred during treatment， and patients were relieved after treatment. Conclusion For the patients with brain metastasis induced by non-small cell lung cancer （NSLC）， patients undergoing the combination of icitinib and radiotherapy can tolerate most of the toxic and adverse effects， and the short-term efficacy is favorable. However， further observation is in need to observe the impact on long-term survival of patients. The method is of clinical application value.

[Key words] Non-small cell lung cancer （NSLC） brain metastases； Icotinib； Radiotherapy； Safety； Therapeutic effect

繼吉非替尼及厄洛替尼之后的，國際上第三個，以及我國第一個EGFR-TKI藥物，便是鹽酸埃克替尼[1]。在晚期NSCLC中，能顯著降低不良反應，療效與吉非替尼相當，在對我國晚期 NSCLC 治療中，其已經成為標準化藥物之一[2]。在全國各種癌癥中，肺癌為有關死亡之首，且肺癌患者致死及治療失敗的重要原因之一，是肺癌腦轉移，且近些年的發病率逐漸升高，當前首要的治療方式是全腦放療[3]。但是，針對于非小細胞肺癌腦轉移患者，埃克替尼聯合放療治療的安全性及療效，在國內有較少有關報道，所以循證醫學依據，在臨床應用中較為短缺[4]。本研究通過對非小細胞肺癌（NSCLC）腦轉移患者，采用埃克替尼聯合放療治療，現報道結果如下。

1 資料與方法