全腦放療聯合欖香烯注射治療多發腦轉移瘤的臨床觀察

胡道卿　李曉東

[摘要] 目的 探討欖香烯注射液聯合全腦放療治療多發腦轉移瘤的效果及不良反應。 方法 收集南京明基醫院2014年4月～2017年4月收治的腦轉移瘤行全腦放療的患者56例，采集患者住院期間的癥狀變化情況及放療后的頭顱MRI復查數據。根據是否使用欖香烯分為欖香烯組和單放組，對兩組患者的腫瘤大小變化、癥狀改善及毒副作用進行比較。 結果 欖香烯組的客觀緩解率（47.37%）與單放組（44.44%）比較，差異無統計意義（P > 0.05）。與單放組比較，欖香烯組能更好地控制頭暈頭痛、嘔吐、疲乏癥狀（P < 0.05），不增加神經系統癥狀控制率和急性放射毒性。在放療遠期反應（放療結束6個月之后）中，欖香烯組記憶力減退的發生率為21.74%，顯著低于單放組的63.64%（P < 0.05）。 結論 全腦放療同步欖香烯注射液治療可增加放療效果和癥狀控制率，但不增加客觀緩解率。與單獨使用放療比較，其不增加急性放射毒性，能在一定程度上降低晚期毒性。對于一般狀況不適合化療或者抗拒化療的腦轉移患者，可考慮使用欖香烯以配合全腦放療。

[關鍵詞] 全腦放療;欖香烯;多發腦轉移瘤;放射增敏

[中圖分類號] R739.41? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1673-7210（2019）06（b）-0080-05

Clinical observation of combined therapy of whole brain radiotherapy and Elemene Injection in the treatment of multiple brain metastases

HU Daoqing1? ?LI Xiaodong2

1.Department of Oncology， BenQ Medical Center? the Affiliated BenQ Hospital of Nanjing Medical University， Jiangsu Province， Nanjing? ?210019， China; 2.Department of Integrated TCM & Western Medicine， BenQ Medical Center? the Affiliated BenQ Hospital of Nanjing Medical University， Jiangsu Province， Nanjing? ?210019， China

[Abstract] Objective To explore the efficacy and side effects of Elemene Injection combined with whole brain radiotherapy in the treatment of multiple brain metastases. Methods A total of 56 patients with brain metastases treated by whole brain radiotherapy in BenQ Medical Center from April 2014 to April 2017 were collected. The changes of symptoms during hospitalization and the data of brain MRI after radiotherapy were collected. According to whether elemene was used or not， the patients were divided into elemene group and radiotherapy group. The changes of tumor size， symptom improvement and toxicity were compared between the two groups. Results The objective response rate between the elemene group （47.37%） and radiotherapy group （44.44%） had no signficant difference （P > 0.05）. Compared with radiotherapy group， elemene group was better in controlling the symptoms of dizziness and headache， vomiting and fatigue （P < 0.05）， without increasing the control rate of neurological symptoms and the conditions of acute radiotoxicity. When it came to the long-term radiotherapy response （after 6 months of radiotherapy）， the incidence rate of memory loss in the elemene group was 21.74%， which was significantly lower than 63.64% in the radiotherapy group （P < 0.05）. Conclusion Whole brain radiotherapy combined with Elemene Injection can increase the effect of radiotherapy and the rate of symptom control. But it can not increase the objective remission rate. Compared with radiotherapy alone， it dosen't increase acute radiotoxicity and can reduce the late toxicity to some extent. Elemene in combination with whole brain radiotherapy may be used in patients with brain metastases who are not suitable for chemotherapy or who are resistant to chemotherapy.

[Key words] Whole brain radiotherapy; Elemene; Multiple brain metastases; Radiosensitization

25%～40%的顱外惡性腫瘤在病程中將發生腦轉移，其中一半左右是多發病灶[1]。常見腦轉移的原發腫瘤有肺癌、乳腺癌、消化道腫瘤等。腦轉移瘤若不進行治療，其自然生存期約為1個月，但是，如果進行內科脫水處理，生存期則延長到2個月。手術雖然作為腦轉移瘤的第一選擇，但在腦轉移的治療應用中受限因素較多，如功能狀態評分（PS）不高、顱內多發、轉移灶位于顱腦深處或與重要解剖結構如腦干、視交叉關系密切[2-3]。其次，因為血腦屏障的存在，化療對于腦轉移瘤的效果也是有限的，Cortes等[4]使用紫杉醇、長春瑞濱等化療藥物治療非小細胞肺癌，統計發現化療藥物在體部病灶的有效率（50%）明顯高于在腦轉移灶的有效率（38%），而且化療會帶來較多的不良反應，降低患者的體力評分。全腦放療對患者身體素質要求低，能直達病灶，對顱腦外無傷害。所以……