脑转移瘤来自黑色素瘤：全脑放疗中联合替莫唑胺是否有作用？
Brain metastases from melanoma: is there a role for concurrent temozolomide in addition to whole brain radiation therapy?
机构信息
Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ 85259, USA.
出版信息
Am J Clin Oncol. 2010 Dec;33(6):633-6. doi: 10.1097/COC.0b013e3181c4c54b.
OBJECTIVES
This study was performed to evaluate the addition of temozolomide (TMZ) to whole brain radiotherapy (WBRT) for brain metastases from melanoma.
METHODS
Seven patients with brain metastases from melanoma were treated on a North Central Cancer Treatment Group (NCCTG) trial (N0274) of TMZ plus WBRT. TMZ was given orally in doses of 200 mg/m² for 5 days every 4 weeks for up to 8 cycles. WBRT was started on the first day of TMZ and included the delivery of 3750 cGy in 15 fractions. In addition, separately analyzed was a cohort of 53 patients treated at the Mayo Clinic who received WBRT alone (39 patients) or WBRT plus TMZ (14 patients).
RESULTS
The median survival of the 7 patients treated on N0274 was 3.6 months with 2 of 7 (29%) failing in brain and 5 of 7 (71%) failing elsewhere. For the other cohort of 53 patients, the median survival was 3.8 months with WBRT alone compared 4.3 months for WBRT plus TMZ (P = 0.5).
CONCLUSIONS
Patients did not appear to benefit from the addition of TMZ to WBRT for the treatment of their brain metastases. Further improvements in outcome will require research to discover more effective systemic therapy and RT techniques.
目的
本研究旨在评估替莫唑胺（TMZ）联合全脑放疗（WBRT）治疗黑色素瘤脑转移。
方法
7 例黑色素瘤脑转移患者参加了一项 TMZ 联合 WBRT 的北中央癌症治疗组（NCCTG）试验（N0274）。TMZ 口服剂量为 200mg/m²，每 4 周连用 5 天，最多 8 个周期。TMZ 开始于 WBRT 的第一天，包括 3750cGy 的 15 个分次照射。此外，还单独分析了在梅奥诊所接受单纯 WBRT（39 例）或 WBRT 联合 TMZ（14 例）治疗的 53 例患者的队列。
结果
N0274 组 7 例患者的中位生存时间为 3.6 个月，7 例中有 2 例（29%）在脑内失败，5 例（71%）在其他部位失败。对于其他 53 例患者，单纯 WBRT 的中位生存时间为 3.8 个月，而 WBRT 联合 TMZ 的中位生存时间为 4.3 个月（P=0.5）。
结论
患者似乎没有从 TMZ 联合 WBRT 治疗脑转移中获益。要进一步改善结果，需要研究发现更有效的全身治疗和放疗技术。
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