摘要
【目的】分析贝伐珠单抗联合头部伽马刀治疗晚期非鳞非小细胞肺癌(non-small cell lung cancer,NSCLC)脑转移的疗效及安全性。【方法】选取2015年2月至2018年2月收治的112例晚期NSCLC脑转移患者,按数字随机分组观察组和对照组,各56例。对照组采用头部伽马刀立体定向放射治疗,观察组在对照组基础上加用贝伐珠单抗静脉注射。比较两组疗效、免疫功能指标变化、Karnofsky(KPS)评分、格拉哥昏迷计分(glasgow coma scale,GCS)、美国国立卫生研究院卒中量表(NIH stroke scale,NIHSS评分)、血清内皮细胞因子(vascular endothelial growth factor,VEGF)指标及肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平,记录治疗期间不良反应发生情况。【结果】观察组客观缓解率显著高于对照组(P<0.05);治疗后观察组CD3+、CD4+、CD4+/CD8+、NK水平显著高于对照组(P<0.05);治疗后观察组KPS、GCS评分显著高于对照组,NIHSS评分显著低于对照组(P<0.05);治疗后观察组血清VEGFA、VEGFB、VEGFC、TNF-α水平均显著低于对照组(P<0.05);观察组高血压、蛋白尿发生率虽显著高于对照组(P<0.05),但可耐受,对症处理后好转不影响后续治疗;两组胃肠道反应、骨髓抑制、肝功能损害发生率比较差异无统计学意义(P>0.05)。【结论】贝伐珠单抗联合头部伽马刀治疗晚期NSCLC脑转移疗效满意,可提高患者免疫功能及生活质量,改善其意识状态及神经功能缺损,其作用机制可能与阻断肿瘤血管生成、控制大脑炎症,抑制肿瘤侵袭转移活性有关。
【Objective】To analyze the curative efficacy and safety of bevacizumab combined with gamma knife radiotherapy for the head in the treatment of brain metastases of advanced non-squamous non-small cell lung cancer(NSCLC).【Methods】A total of 112 patients with brain metastases of advanced NSCLC who were admitted to the hospital from February 2015 to February 2018 were selected.They were divided into the observation group and control group by the random number table method,56 cases per group.The patients in the control group were treated with gamma knife radiotherapy for the head,and those in the observation group were treated with intravenous injection of bevacizumab on the basis of the control group.The curative efficacy,changes of immune function indexes,Karnofsky performance scale(KPS)scores,Glasgow coma scale(GCS)scores,National Institutes of Health Stroke Scale(NIHSS)scores,levels of serum endothelial cell factor(VEGF)and tumor necrosis Factor-α(TNF-α)were compared between the two groups.The incidence of adverse reactions during the treatment was recorded.【Results】The objective response rate of the observation group was significantly higher than that of the control group(P<0.05).The levels of CD3+,CD4+,CD4+/CD8+and NK in the observation group after treatment were significantly higher than those in the control group(P<0.05).KPS and GCS scores of the observation group after treatment were significantly higher than those of the control group,and the NIHSS score was significantly lower than that of the control group(P<0.05).The levels of serum VEGFA,VEGFB,VEGFC and TNF-αin the observation group were significantly lower than those in the control group(P<0.05).Although the incidence of hypertension and proteinuria in the observation group was significantly higher than that in the control group(P<0.05),it was tolerable and the improvement after symptomatic treatment did not affect subsequent treatment.There was no significant difference in the incidence of gastrointestinal reaction,bone marrow suppression and liver function damage between the two groups(P>0.05).【Conclusion】Bevacizumab combined with gamma knife radiotherapy for the head is effective in the treatment of brain metastases of advanced NSCLC.It can improve the immune function and quality of life of patients.It can also improve their consciousness and neurological deficits.The mechanism may be related to blocking tumor angiogenesis,controlling brain inflammation and inhibiting activity of tumor invasion and metastasis.
作者
王岩
WANG Yan(Department of Oncology,Characteristic Medical Center of PAP,Tianjin 300162,China)
出处
《武警后勤学院学报（医学版）》
CAS
2020年第5期41-45,共5页
Journal of Logistics University of PAP（Medical Sciences）
关键词
贝伐珠单抗
放疗
晚期非鳞非小细胞肺癌
脑转移
疗效
Bevacizumab
Radiotherapy
Advanced non-squamous non-small cell lung cancer
Brain metastasis
Curative efficacy
作者简介
王岩,硕士,主治医师,主要从事肿瘤放化疗及靶向药物、免疫治疗等。
