| Objective:To evaluate the recent efficacy,adverse effects, and survival rates of the three dimensional conformal radiotherapy(3D-CRT) combined with the chemotherapy of TP(paclitaxel liposome+cisplatin) regimen for the brain metastasis from non-small cell lung cancer.To Compare the recent efficacy,survival rates and adverse effects differences between the whole brain radiotherapy with concurrent chemotherapy and radiotherapy to 30Gy whole brain again when combined with chemotherapy.To study the better time of the whole brain radiotherapy combined with chemotherapyMethods:To obtain 41 patients with brain metastasis from lung cancer from Hebei People's Hospital Oncology department during December 2008 to December 2009. There are 25 males and 16 females.The median age was 60 years (range 31-84 years); 13 patients were squamous carcinoma, 24 patients were adenocarcinoma, 4 patients were others; 7 patients Karnofsky performance status(KPS) of all were less than 70, the Other 34 patients KPS were more than 70. the brain metastases more than 3 were 21 cases, less than 3 were 20 cases. extracranial metastasis were 12 cases, no extracranial metastases were 29 cases.According to Radiation Therapy Oncology Group (RTOG) brain metastases Recursive partitioning analysis (RPA),all patients were divided into 3 layers. and then each layer was randomly divided into two groups A or B by radiotherapy and chemotherapy Order. the patients in group A were treated by whole brain radiotherapy concurrent combined with TP regimen chemotherapy, the patients in group B were treated by chemotherapy combined with until whole brain radiotherapy to 30Gy. The radiotherapy with three dimensional conformal radiotherapy(3D-CRT) was delivered in 2Gy per fraction and 5 fractions per week. at first,the patients were treated by whole brain radiotherapy with the dose of 40Gy/20f.Then three-dimensional conformal radiotherapy was added to the focus with the total dose of 50–60Gy/25-30f. the patients with the brain metastasis>5 were treated by whole brain radiotherapy with the total dose≤50Gy/25f/5w.chemotherapy formula: paclitaxel liposome(135～175mg/m2 ) was infused by intravenous (iv) for>3h on day 1,combined with cisplatin(DDP)20mg on day 1～5 and repeated every 21 days.Dexamethasone 5mg,Cimetidine 400mg and Diphenhydramine 50mg were intravenously administered for preventing hyper-sensitivity reactions 30min before Lipusu. After 2 cycles , the chemotherapy was evaluated. If the treatment were effective , the chemotherapy continuously was offered for 3-4 cycles. The the recent efficacy, adverse effects, and survival rates were observed during and after the treatment. response rates and toxicities Survival was calculated from the day of study entry until the date of death was used to estimate and the survival curves were drew. The baseline characteristics and the differences of the recent efficacy,adverse effects were tested by The Pearson x2 test and Fischer's exact test,the survival rates were estimated by Kaplan-Meier's method, the difference of the survival rates was tested by the log-rank test .Results:4 patients of all were not completed because of serious adverse treatment, 2 case in group A rejected to radiotherapy due to severe intracranial hypertension reactions,1 case refused to continue chemotherapy due to IV myelosuppression occurred. 1 cases in group B stoped treatment because of the poor physical condition (KPS score <30 )during the treatment. The remaining 37 cases (90.2%) completed the treatment. All patients were followed up, no lost cases. In addition to 1 patient in group B died due to heart disease, the remaining 36 patients can evaluate the efficacy and adverse reactions. The overall response rates for A and B group were 47.1% and 57.9% respectively. their complete response rates were 5.8% and 10.5% respectively. unchanged and progress rates of the two group were 35.3%,31.7%and17.6%,10.5%. The response rates of two groups by Fisher exact test tests, no significant difference (P>0.05).For all 41 patients were followed up, and half-year survival rate were observed, Calculated according to Kaplan-Mierer law, the chemoradiotherapy group six months survival rate was 60%. the group six months survival rate was 87.2%. By Logrank test,χ2=3.27, P=0.06>0.05 no significant difference. Although six months survival rates in group A and B have no significant difference, it have trend that survival rate of group is higher than group B. To evaluat the adverse reaction of the 41 patients. The toxicity in both groups are maily bone marrow suppression, nausea, vomiting and acute radiation damage to the nervous system toxicity.The rate of side effect in the group A were 90%(18/20), 100%(20/20),100%(20/20)and76.29%(16/21),85.7%(18/21),100%(21/21)in B group. The incidence of 2 degree vomiting was 55% (11/20) and 19% (4/21) of two groups, By x2 test, P =0.014<0.05, significantly different. The incidence of 3 degree acute radiation damage to the nervous system was 50%(10/20)and 14.3%(3/21) of two groups, By x2 test, P =0.016<0.05, significantly different.There were 4 cases(20%) and 5 cases(23.8%) had grade 1 hepatic toxicity in group A and B, no more than grade 2 hepatic toxicity occurred.Conclusions:(1)Whole brain radiotherapy combined with TP regimen chemotherapy have a better recent efficacy and survival rates for the brain metastasis from non-small cell lung cancer.(2)Treated by whole brain radiotherapy to 30Gy can increase the permeability of blood-brain barrier and this time combined with chemotherapy has the trends to improve recent efficacy and survival rates compared with concurrent chemoradiotherapy.(3)Combined with chemotherapy until whole brain radiotherapy to 30Gy have less adverse effects and more tolerance for the patient compared with concurrent chemoradiotherapy.
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