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目的探讨培美曲塞联合福莫司汀治疗肺腺癌脑转移的效果和安全性。方法无法行手术治疗且无神经系统症状肺腺癌脑转移患者52例,随机分为观察组和对照组各26例。观察组给予培美曲塞500 mg/m~2,静脉滴注30 min,第1天;福莫司汀75 mg/m~2,静脉滴注1 h,第2、8天;对照组培美曲塞用法、用量同观察组,并给予奥沙利铂100 mg/m~2,静脉滴注2 h,第2天。2组均21 d为1个化疗周期。每治疗2个周期评定疗效,比较2组近期疗效和不良反应发生情况,随访18个月观察生存情况。结果观察组完成6~8个周期化疗,对照组完成4~8个周期化疗;化疗6个周期,观察组有效率(53.85%)高于对照组(15.38%)(P<0.05);观察组中位无进展生存期(8.5个月)、中位生存时间(13.6个月)与对照组(6.2、12.4个月)比较差异均无统计学意义(P>0.05);观察组1 a生存率(76.9%)高于对照组(46.2%)(P<0.05);治疗期间,观察组血小板减少发生率(80.77%)高于对照组(38.46%)(P<0.05),余不良反应发生率比较差异无统计学意义(P>0.05)。结论培美曲塞联合福莫司汀治疗肺腺癌脑转移疗效良好,但可引起血小板减少。
Objective To investigate the efficacy and safety of pemetrexed combined with fotemustine in treatment of brain metastases of lung adenocarcinoma. Methods 52 cases of brain metastases of lung adenocarcinoma without surgical treatment and without neurological symptoms were randomly divided into observation group and control group with 26 cases each. The observation group was given pemetrexed 500 mg / m ~ 2, intravenous infusion of 30 min on the first day; fomestine 75 mg / m ~ 2, intravenous infusion 1 h, 2,8 days; The use of meticillin, the same amount of observation group, and given oxaliplatin 100 mg / m ~ 2, intravenous infusion of 2 h, the first two days. Both groups were 21 days for a chemotherapy cycle. The curative effect was evaluated on 2 cycles per treatment. The recent curative effects and adverse reactions were compared between the two groups. The follow-up of 18 months was used to observe the survival. Results The observation group completed 6 to 8 cycles of chemotherapy and the control group completed 4 to 8 cycles of chemotherapy. In the 6 cycles of chemotherapy, the observation group (53.85%) was higher than the control group (15.38%) (P <0.05) The median progression-free survival (8.5 months), median survival time (13.6 months) and control group (6.2,12.4 months) showed no significant difference (P> 0.05) (76.9%) was higher than that of the control group (46.2%) (P <0.05). During the treatment, the incidence of thrombocytopenia in the observation group was higher than that in the control group (80.77% vs 38.46%, P <0.05) The difference was not statistically significant (P> 0.05). Conclusion Pemetrexed combined with fotemustine can effectively treat brain metastases of lung adenocarcinoma, but it can cause thrombocytopenia.