肺癌血管生成研究在介入治疗中的临床应用

Clinical Application of Angiogenesis of Lung Cancer in Interventional Therapy

目的:研究肺癌的血管生成临床意义,为临床介入治疗提供科学依据.方法:对病理证实的38例肺癌,经螺旋CT双期增强扫描、DSA,了解肿瘤血管生成情况.行支气管动脉导管化疗和栓塞治疗(介入治疗),部分实体肿瘤直径大于4cm配合放射治疗.结果:①中央型病变13例,其中小细胞肺癌3例,非小细胞肺癌10例.周围型病变25例,最大直径1.5～13.5cm,中位值4.5cm.其中小细胞肺癌5例,非小细胞肺癌20例;②癌灶强化峰值(PV)26例45～70HU,10例25～45HU,2例10～25HU;DSA 2例染色稀疏、13例染色呈不均匀网织状、23例染色浓密;③5例小细胞肺癌行2次支气管动脉介入治疗,3例小细胞肺癌行3次支气管动脉介入治疗;其中2例在介入治疗周期穿插放射治疗5000～7000Gr;CR87.5%(7/8),PR12.5%(1/8).4例非小细胞肺癌行2次支气管动脉介入治疗,19例非小细胞肺癌行3次支气管动脉介入治疗,7例非小细胞肺癌行4次支气管动脉介入治疗;其中7例介入治疗周期穿插放射治疗5000～7000Gr;CR86.7%(26/30),PR10%(3/30),NR3.3%(1/30).结论:根据影像技术来准确检出和量化肺癌血管生成,为临床介入治疗方案的制定和肿瘤综合治疗有很高的指导价值.

Objective:To investigate the clinical significance of angiogenesis in lung cancer and provide scientific basis for interventional therapy.Methods:In 38 pathologically confirmed lung cancers,multi-slice helical CT scanning and DSA were carried out for detecting angiogenesis of tumors.Chemotherapy via bronchial arterial catheter and embolization(interventional therapy)were performed,and combined with radiotherapy for those solid tumors larger than 4cm in diameter.Results:①Central type of lung cancer was found in 13 cases,among which 3 were with small cell cancer,10 with non-small cell cancer.Peripheral type of lung cancer was found in 25 cases with tumor average 4.5cm in diameter(ranges,1.5 to 13.5cm),among which 5 were with small cell cancer,20 with non-small cell cancer.②The peak value(PV) of focus accentuation ranged from 45 to 70 HU in 25 cases,25 to 45 HU in 10 and 10 to 25 HU in 2.Staining by DSA was sparse in 2 cases,inhomogenous reticulated in 13,dense in 23.③2 interventional therapy were performed in 5 cases of small cell lung cancer and 4 non-small cell ones,3 in 3 small cell ones and 19 non-small cell ones,4 in 7 non-small cell ones.Periodically combined radiotherapy in dose from 5000 to 7000 Gr was performed in 2 small cell lung cancer and 7 non-small cell ones.The rate of CR and PR in small cell lung cancer was respectively 87.5% and 12.5%,that of CR,PR and NR in non-small cell one 86.7%,10% and 3.3%.Conclusion:Detection and quantization of angiogenesis of lung cancer based on image is valuable in interventional or combined therapy.