【摘要】 目的 比较全脑放射和靶向治疗序贯疗法与单独应用靶向治疗表皮生长因子受体（EGFR）突变阳性非小细胞肺癌（NSCLC）伴脑转移患者的临床疗效。方法 选取2009年9月—2015年1月天津医科大学肿瘤医院收治的107例EGFR突变阳性NSCLC伴脑转移患者作为研究对象，根据治疗方法分为序贯治疗组53例和靶向治疗组54例。序贯治疗组患者先接受全脑放射治疗再接受EGFR酪氨酸激酶抑制剂（TKIs）治疗，而靶向治疗组患者仅接受EGFR TKIs治疗。比较两组患者治疗效果、治疗期间不良反应发生率及生存情况。结果 序贯治疗组颅内疾病控制率和有效率为84.9%和79.2%，均高于靶向治疗组的61.1%和59.3%，差异均有统计学意义（χ~2=7.665、5.009,P<0.05）；两组颅外疾病控制率和有效率比较差异无统计学意义（P>0.05）。两组颅内无进展生存期（PFS）和颅外PFS差异均无统计学意义（P>0.05）；随访两年，两组生存率比较差异无统计学意义（P>0.05）。两组均未出现不可耐受不良反应。结论 EGFR突变的NSCLC伴脑转移患者应用全脑放射序贯EGFR TKIs治疗与EGFR TKIs单药治疗相比，能提高颅内疾病控制率和有效率，但是未能改善总生存率、颅内外PFS。因此，临床可以根据患者实际情况选择最佳的治疗方案，以改善患者预后。更多还原

【Abstract】 Objective To compare the clinical efficacy of whole brain radiation and targeted therapy sequential therapy and targeted therapy alone in the treatment of patients with epidermal growth factor receptor(EGFR)mutation-positive non-small cell lung cancer(NSCLC)with brain metastases. Methods A total of 107 patients with EGFR mutation-positive NSCLC with brain metastases treated in Tianjin Medical University Cancer Hospital from September 2009 to Jannuary 2015 were selected as subjects and divided into sequential therapy group with 53 cases and tageted therapy group with 54 cases according to treatment methods. The patients in the sequential therapy group received whole brain radiation therapy first followed by EGFR tyrosine kinase inhibitors(TKIs)treatment,while patients in the targeted therapy group only received EGFR TKIs treatment. The treatment effect,incidence of adverse reactions during treatment and survival status of patients in the two groups were compared. Results The control rate and effective rate of intracranial diseases in the sequential therapy group were 84.9% and 79.2%,which were higher than those in the targeted therapy group with 61.1% and 59.3%,and the differences were statistically significant（χ~2=7.665,5.009,P <0.05）. There were no statistically significant differences in the control rate and effective rate of extracranial diseases between the two groups(P <0.05). There were no statistically significant differences in intracranial progression free survival(PES)and extracranial PFS between the two groups(P>0.05). There was no statistically significant difference in survival rates between the two groups after two years of follow-up(P>0.05). Neither group experienced intolerable adverse reactions(P<0.05).Conclusion Compared with EGFR TKIs monotherapy,whole brain radiation therapy with EGFR TKIs could improve intracranial disease control and efficacy in NSCLC patients with EGFR mutations and brain metastases. However,it did not improve overall survival and prolong intracranial and extracranial PES.Therefore,clinical practice should choose the best treatment plan based on the actual situation of patients to improve their prognosis.更多还原