吉非替尼联合胸腔内化疗治疗伴有恶性胸水的非小细胞肺癌的临床研究

Efficacy and safety of gefitinib combined with intrathoracic chemotherapy in advanced non-small cell lung cancer patients with pleural effusion

目的:探讨吉非替尼联合胸腔内化疗治疗伴有恶性胸水的非小细胞肺癌的疗效和安全性。方法:26例伴有中、大量恶性胸水的晚期非小细胞肺癌患者,采用胸腔置管引流尽量放干胸水后,胸腔内注射化疗药物顺铂(DDP)40mg/m2、香菇多糖2mg、地塞米松10mg,从胸腔内化疗后的第3天口服吉非替尼250mg/d,直到病变进展或其他原因停药。每3个月对病灶进行1次CT检查。结果:第3个月CT复查结果显示:全组胸水控制有效率为69.2%(18/26),肿瘤病灶治疗有效率为34.6%(9/26),疾病控制率73.1%(19/26),临床受益反应为88.5%(23/26)。中位疾病进展时间(TTP)为8.2个月(95%可信区间:1.8-14.2月),中位生存期(MST)为12.4个月(95%可信区间:3.1-37.4月),1年生存率为46.2%(12/26)。主要不良反应是Ⅰ、Ⅱ度皮肤毒性。结论:吉非替尼联合胸腔内化疗治疗伴有恶性胸水的非小细胞肺癌具有较好的疗效和安全性。

Objective：To evaluate the efficacy and safety of gefitinib combined with intrathoracic chemotherapy in advanced non - small cell lung cancer patients with pleural effusion. Methods： Twenty six patients with advanced NSCLC and medium or abundant pleural effusion were selected. Pleural effusion was emptied with thoracentesis. The intrathoracic chemotherapy： cisplatin （DDP） 40mg/m2, lentinan 2mg, dexamethasonen lOmg. All patients received gefifinib of 250mg/d after 3 days from intrathoracic chemotherapy until disease progression. The tumor was examined by CT every 3 months. Results ：The response rate of pleural effusion was 69.2% （ 18/26 ）. Tumor response rate was 34.6% （9/26）. Disease control rate was 73.1% （19/26）. Clinical benefit response was 88.5% （23/26）. The medi- an time to progression was 8.2 months （95% CI, 1.8 -14.2 months）, the median survival time was 12.4 months （95%CI,3.1 -37.4 months）. One -year survival rate was 46.2% （12/26）. The main side effect was grade I or lI skin toxicity. Conclusion： Gefitinib combined with intrathoracic chemotherapy is feasible and effective for treatment in advanced non - small cell lung cancer patients with pleural effusion.