| Background: Brain metastasis was one of the most important complications of theNSCLC (non-small cell lung cancer), which was also an important factor of affectingthe survival and quality of life of the patients. Brain radiotherapy can effectively relievethe symptoms of the patients and enhance their quality of life, cooperate with gefitinibmay improve the curative effect, but the duration of the effectiveness and influence onquality of life has no related research. The lack of large sample results in domesticseems that further observation may be necessary.Objective: To observe the effect of brain metastasis on survival and quality of life ofthe patients whose NSCLC (non-small cell lung cancer) have been effectively treated bygefitinib for over six months.Methods: To diagnose whether brain metastasis based on MRI. The patient with brainmetastasis was acted as the trial group, and that without brain metastasis as control one.The trial group was treated with gefitinib with or without brain radiotherapy, while thecontrol group received gefitinib only. The Karnofsky Performance Status（KPS）andfunctional living index cancer scale（FLIC）were used for evaluate the quality of life,meanwhile the mini-mental state examination(MMSE) was used for evaluate thecognitive disorder of the patients with brain metastases. The side effects were observedby CTCAE3.0when patients receive gefitinib treatment, until death or the end offollow-up. SPSS13.0software package used for statistical analysis, count data andsurvival analyze was test by x2test and Kaplan-Meier log-rank, P <0.05was considered statistically significant. The two groups were compared from such aspects as overallsurvival (OS), progression-free survival (PFS), the quality of life(QOL), and cognitivedisorder.Results: From September1st,2006to November30th,2011,88patients were enrolled,the median follow-up time was20.0months, the average follow-up period was21.8months(range,7.0～51.0moths).There were27cases in the trial group (22of them gotbrain metastasis before gefitinib treatment and5of them got brain metastasis aftergefitinib) and61cases in the control group, there was no statistically significantdifference showed in the OS（22.50±10.50months vs21.95±12.75months，p=0.360）、PFS（17.24±10.76months vs16.15±11.78months，p=0.240）of the two groups. Twogroups’1-,2-,3-years survival rate were85%vs82.6%（p=0.811），35%vs39.1%（p=0.751）and15.0%vs10.9%（p=0.637）respectively，which showed no statisticalsignificance. When the treatment was effectual, the KPS score increased significantlyand stay at a high level in a certain period. Karnofsky Performance Status didn’tdecrease significantly when brain metastasis was detected during the treatmentprocedure. Two cases (3.3%) in the control group presented cognitive disorder, and9cases (33.3%) in the trial group did so, their MMSE score decrease significantly, someof them rise again after the brain metastasis was under control. The side effects ofgefitinib usually showed slightly in skin and digestive tract，which patients can tolerate.Conclusion Gefitinib has certain effects on the treatment of brain metastasis in NSCLCpatients. As regard to patients whose pulmonary lesion could be controlled by gefitinib,brain metastasis is not the main factor affecting the following life time and the qualityof life of the patients. During the treatment procedure of NSCLC with Gefitinib, thebrain metastases should not be simply regarded as the disease progression to change thetreatment plan, continuous treatment by Gefitinib in combination with brain radiotherapy was still effective. We should pay attention to the cognitive disorder of thepatients with brain metastases, meanwhile, the cognitive disorder without brainmetastases worth our further discussion. |
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