支气管动脉灌注与高剂量率支气管腔内放疗联合治疗非小细胞肺癌(附27例报道)

Bronchial Artery Infusion in Combination with High Dose Rate Intrabronchial Brachytherapy with Remote Afterloading Technique for Non Small Cell Lung Cancer

目的: 探讨支气管动脉灌注化疗(BAI) 与高剂量率支气管腔内后装放射治疗( HDRIBB) 两项新技术联合治疗非小细胞肺癌的可行性、方法学和临床价值。材料与方法: 对27 例非小细胞肺癌采用BAI 与铱192高剂量率支气管腔内后装放射治疗两项新技术进行序贯或交替方式的联合治疗,观察主、客观近期疗效、毒副反应与并发症。结果: 24 例有临床症状的患者,71 % (17/24) 得到不同程度的改善;27 例中92 .6 % (25/27) 的患者KPS 评分提高或稳定。近期客观缓解率:CR 8 例,PR 15 例,有效率(CR+ PR) 为85 % ;病理组织学疗效:显效2 例,有效5 例,部分有效2 例。结论: 支气管动脉灌注化疗与铱192 高剂量率支气管腔内后装放射治疗联合治疗非小细胞肺癌为有效方案,有较好的近期主、客观疗效,对中央型和周围型肺癌均适用。联合治疗安全可行,毒副反应及并发症轻微。

Objective: To study the feasibility and methodology of the protocol of bronchial artery infusion (BAI) in combination with 192 iridium (Ir 192 ) high dose rate intrabronchial brachytherapy (HDR IBB) using remote afterloading technique for non small cell lung cancer (NSCLC).Materials and Methods:Of 27 NSCLC patients treated with sequential or alternating protocol of BAI in combination with HDR IBB, 9 received surgery after the combined treatment. The clinical improvement, Karnofsky performance status (KPS), radiological and histologic response, the change in gross specimen, the toxicity and acute complications, etc. were observed and evaluated.Results:Of 24 patients having symptoms, 17(71%) experienced significant clinical improvement. Of the total 27 patients, 25(92.6%) obtained significant or moderate improvement in KPS, 23(85%) showed objective response, presenting as complete remission (CR) or partial remission (PR). As for the histologic effects in 9 patients, grade Ⅲ in 2, grade Ⅱ in 5 and grade Ⅰ in 2 cases were obtained.Conclusion: The protocol studied is an effective and safe method for NSCLC, a suitable treatment for both central and peripheral type of lung cancer. It is of great clinical value to use the combined protocol for the treatment of inoperative NSCLC in its early stage and the local recurrence after complex treatment.