静脉联合支气管动脉灌注化疗后手术治疗ⅢA期非小细胞肺癌

Application of intravenous combined with interventional neoadjuvant chemotherapy to patients with StageⅢA non-small-cell lung cancer

目的探讨ⅢA期非小细胞肺癌(NSCLC)诱导化疗的理想模式。方法98例ⅢA期NSCLC患者分成3组(1)静脉联合支气管动脉介入性诱导化疗组32例;(2)全身性静脉诱导化疗组34例;(3)单纯手术组32例。结果联合诱导化疗组缓解率(RR)81.3%明显高于单纯静脉化疗组61.8%;两组诱导化疗后的手术切除率分别为100%和94.1%,均显著高于单纯手术组的78.1%,两组间无显著差别;联合化疗组肺叶切除的比例(68.8%)明显高于静脉化疗组(48.5%),p<0.05。较之单纯手术,两诱导化疗组患者手术失血量明显增加;心律失常的发生率静脉化疗组明显高于联合化疗组。1年存活率:联合化疗组为85.2%(23/27)。3年存活率:两诱导化疗组间无显著差别,均显著高于单纯手术组的38.9%(7/18)。结论静脉联合支气管动脉灌注诱导化疗后手术治疗ⅢA期NSCLC,效果良好,毒副反应低,是一高效低毒的治疗模式。

Objective To discuss the available mode of neoadjuvant chemotherapy in patients with StageⅢA non-small-cell lung cancer.Methods Ninty-eight patients with StageⅢA non-small-cell lung cancer were divided into three groups. Group A of 32 cases received one course systemic intravenous chemotherapy and another course bronchial arterial infusion followed by surgical resection. Group B of 34 cases received two courses intravenous chemotherapy before surgery, and Group C (control group) of 32 cases received surgery only. Results The release rate (RR) of patients in Group A was 81.3% which was significantly higher than that in Group B (61.8%) (p<0.05). The resection rate in Group A and B was 100% and 94.1% respectively, both higher than that of the control group (78.1%) (p<0.05). The simplicity lobectomy rate in Group A (68.8%) was remarkablely higher than that in Group B (48.4%): p<0.05. Significant difference of the amount of bleeding during pero-operative period was observed between Group A and C (435±55ml vs 325±70ml, p<0.05), B and C (460±65ml vs 325±70ml, p<0.05). The incidence of cardiac arrhythimia in Group A was lower than that in Group B. The 1-year survival rate was 85.2% (23/27) in Group A, which was significantly higher than that in Group B 68.9% (20/29) p<0.05 and Group C 59.2% (16/27), p<0.01. The 3-year survival rate in Group A was 64.7% (11/17), similar to that in Group B 61.1% (11/18). The 1-year and 3-year survival rates in neoadjvuant chemotherapy groups were higher than that of the control group 38.9% (7/18) (p<0.01). Conclusion Intravenous combined with interventional neoadjuvant chemotherapy is a safe and effective mode in the treating StageⅢA non-small-cell lung cancer.