非小细胞肺癌脑转治疗方法荟萃（更新于2011年11月9日）

老马 · 发表于 2013-7-16 23:43:36

Radiotherapy is often used palliatively in patients with metastatic lung cancer in the interest of achieving a better quality of life. But whether survival after palliative radiation justifies using the modality is debatable. Clinicians from Louisiana shed some light on the issue with a study that looked at prognostic factors in lung cancer with brain metastases. Would these patients be better off with hospice or supportive care?

RESULT: Short survival after palliative radiotherapy for brain metastases in lung cancer: Does the end justify the means?
American Journal of Hospice & Palliative Medicine | Jun 9, 2013 (Free abstract. Full text $32)

Chemoradiotherapy has become a go-to in cancer treatment, but this pairing is not always successful. One group of researchers tested the regimen of stereotactic radiosurgery, whole-brain radiation, temozolomide(Drug information on temozolomide) (Temodar), and erlotinib (Tarceva) in non-small cell lung cancer patients with brain metastases. They describe their trial results and explain why they were less than pleased with survival outcomes.

RESULT: A phase 3 trial of whole brain radiation therapy and stereotactic radiosurgery alone versus WBRT and SRS with temozolomide or erlotinib for non-small cell lung cancer and 1 to 3 brain metastases: Radiation Therapy Oncology Group 0320
International Journal of Radiation Oncology, Biology, Physics (PubMed) | Apr 1, 2013 (Free abstract. Full text $30)

老马 · 发表于 2013-7-16 23:49:32

http://www.ncbi.nlm.nih.gov/pubmed/23391814
A phase 3 trial of whole brain radiation therapy and stereotactic radiosurgery alone versus WBRT and SRS with temozolomide or erlotinib for non-small cell lung cancer and 1 to 3 brain metastases: Radiation Therapy Oncology Group 0320.
Sperduto PW, Wang M, Robins HI, Schell MC, Werner-Wasik M, Komaki R, Souhami L, Buyyounouski MK, Khuntia D, Demas W, Shah SA, Nedzi LA, Perry G, Suh JH, Mehta MP.
SourceMetro MN CCOP, Minneapolis, Minnesota, USA. psperduto@mropa.com

Abstract
BACKGROUND: A phase 3 Radiation Therapy Oncology Group (RTOG) study subset analysis demonstrated improved overall survival (OS) with the addition of stereotactic radiosurgery (SRS) to whole brain radiation therapy (WBRT) in non-small cell lung cancer (NSCLC) patients with 1 to 3 brain metastases. Because temozolomide (TMZ) and erlotinib (ETN) cross the blood-brain barrier and have documented activity in NSCLC, a phase 3 study was designed to test whether these drugs would improve the OS associated with WBRT + SRS.

METHODS AND MATERIALS: NSCLC patients with 1 to 3 brain metastases were randomized to receive WBRT (2.5 Gy × 15 to 37.5 Gy) and SRS alone, versus WBRT + SRS + TMZ (75 mg/m(2)/day × 21 days) or ETN (150 mg/day). ETN (150 mg/day) or TMZ (150-200 mg/m(2)/day × 5 days/month) could be continued for as long as 6 months after WBRT + SRS. The primary endpoint was OS.

RESULTS: After 126 patients were enrolled, the study closed because of accrual limitations. The median survival times (MST) for WBRT + SRS, WBRT + SRS + TMZ, and WBRT + SRS + ETN were qualitatively different (13.4, 6.3, and 6.1 months, respectively), although the differences were not statistically significant. Time to central nervous system progression and performance status at 6 months were better in the WBRT + SRS arm. Grade 3 to 5 toxicity was 11%, 41%, and 49% in arms 1, 2, and 3, respectively (P<.001).

CONCLUSION: The addition of TMZ or ETN to WBRT + SRS in NSCLC patients with 1 to 3 brain metastases did not improve survival and possibly had a deleterious effect. Because the analysis is underpowered, these data suggest but do not prove that increased toxicity was the cause of inferior survival in the drug arms.

老马 · 发表于 2013-7-17 00:01:28

这项3期临床结果显示，脑部放疗联合特或者替莫无好处。

哀恸的人有福了 · 发表于 2013-7-18 17:24:33

家人7月5日发现脑转，现在正在全脑放疗，口服特罗凯，看了老马上面的帖子，心里好纠结啊！

huanzi · 发表于 2013-7-19 16:02:14

脑转50天，正版特罗凯复查结果：比5月28号稍有减轻，癌胚原3,03降至2,83.说明特有效。继续服用特罗凯，请问老马老师，在脑转的情况下也需要轮换药吗？不是说只有特罗凯入脑吗？下步怎么走，盼指导。这月准备脉冲一下（2,1,0片）不知对否，看到帖子有这样试的，请关注脑转的病人，和家属，有经历的来说说，谢谢!

zyhwhq · 发表于 2013-7-27 06:21:23

父74，肺腺癌T2N0MO，12年2月左下肺切除，18外显因子突变，EGFR+++，VEGFR-2 +，HER2 -。13年7月脑出血，确诊为单发脑转。因从未做过放化疗，父亲状态尚好，偶尔头晕健忘。准备上印度易瑞沙。请教老马，是应该先全脑放还是先上靶向？

ritali · 发表于 2013-8-11 22:57:23

哀恸的人有福了发表于 2013-7-18 17:24

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家人7月5日发现脑转，现在正在全脑放疗，口服特罗凯，看了老马上面的帖子，心里好纠结啊！

我们家都放过了，联合了特，联合替。效果未知。纠结的方案，现在不敢再用替了，感觉我们家每次用替都有不好的反应。

mgtaotao · 发表于 2013-8-16 09:08:46

我们家EGFR基因没有突变，免疫组化VEGF HER ALK也全部是阴性，2012年10月24日开始第一次化疗培美+奈达铂，一共化疗了6次+单药培美一次。于2013年4月22日结束化疗（这时医生发现培美耐药了），8月7日增强核磁发现脑转多发（目前脑转没有症状），现在医生建议脑部全放。请大家指点现在是不是脑部全放的最佳时候，全放后化疗用什么方案较好。恳请各位帮我出出主意。