^(32)P玻璃微球经支气管动脉栓塞内照射治疗中晚期肺癌的对比研究

Comparative study of bronchi artery radioembolization with phosphorus-32 glass microspheres and interventional chemotherapy alone in patients with intermediate and advanced lung cancer

目的:评价介入化疗合并32P玻璃微球(phosphorus32glassmicrospheres,32PGMS)经支气管动脉栓塞内照射治疗支气管肺癌与单纯介入化疗的疗效.方法:将支气管肺癌48(腺癌9、鳞癌24、腺鳞癌1和小细胞肺癌14)例按入院先后顺序随机分为两组.内放射治疗组在全身化疗2个周期后4wk行支气管动脉灌注化疗和32PGMS经支气管动脉栓塞内照射治疗;传统治疗组在全身化疗2个周期后4wk经支气管动脉灌注化疗.两组的全身化疗方案一致.结果:内放射治疗组完全缓解(CR)5例(21%),部分缓解(PR)15例(62%),稳定(SD)3例(12%),进展(PD)1例(4%),有效率(CR+PR)83%(20/24);而传统治疗组CR2例(8%),PR10例(42%),SD8例(33%),PD4例(17%),RR12例(50%).两组差异明显(83%vs50%,χ2=6.00,P=0.01).而两组术后并发症的发生率无显著差异(8%vs17%,P=0.666).结论:32PGMS经支气管动脉栓塞内照射治疗支气管肺癌的近期疗效优于传统介入组,而不良反应发生率与传统方法无差异.

AIM: To compare the clinical effects of interventional chemotherapy combined with bronchi artery radioembolization with phosphorus-32 glass microspheres ( 32P-GMS) and the effects of interventional chemotherapy on patients with advanced lung cancer. METHODS: A total of 48 patients with intermediate and advanced lung cancer were enrolled in the study, including 9 adencarcinoma cases, 24 squamous carcinoma cases, 1 adenosquamous carcinoma and 14 small cell lung carcinoma cases. All the patients received 2 cycles of systemic chemotherapy [cyclophosphamide adrimycin platinum (CAP) remedy for non-small cell lung cancer (NSCLC) and VP-16 platinum (EP) for small cell lung cancer (SCLC)] and were randomized into the experimental group and control group by order of their admission. At the fourth week after the second cycle, the experimental group was given interventional chemotherapy (CAP) combined with bronchi artery radioembolism with 32P-GMS, while the control group was only treated by interventional chemotherapy (CAP) alone. RESULTS: In the experimental group, 21% (5/24) achieved complete remission (CR), 62% (15/24) achieved partial remission (PR), 12% (3/24) had no real changes and 1 patient deteriorated (4%). The overall response (CR+PR) rate was 83% (20/24). However, in the control group, 8% (2/24) achieved CR, 42% (10/24) CR, 33% (8/24) had no real changes and 4 patients deteriorated (17%). The overall response (CR+PR) rate was 50% (12/24). The differences of overall response rate between the two groups were statistically significant (83% vs 50%, χ2=6.00, P= 0.01). The incidence of major postoperative complications in both groups was of no significant difference (8% vs 17%, P=0.666). CONCLUSION: The short-term effect of chemotherapy combined with bronchi artery radioembolization with 32P-GMS is better than that of chemotherapy alone. But the incidence of major side effects in both groups is of no significant difference.