^(125)Ⅰ粒子组织间植入联合支气管动脉灌注化疗治疗肺癌的疗效观察

CT-guided percutaneous ^(125)I seed implantation combined with bronchial arterial infusion chemotherapy for lung cancers:observation of therapeutic efficacy

目的评价CT导引下^(125)Ⅰ粒子组织间植入联合经支气管动脉灌注化疗治疗进展期肺癌的疗效和安全性。方法 108例Ⅲ～Ⅳ期肺癌患者随机分为联合治疗组和灌注化疗组,联合治疗组43例57个病灶接受CT导引下^(125)Ⅰ放射性粒子植入后,联合同步支气管动脉内吉西他滨和奥沙利铂(GP),方案灌注化疗2～4个周期;灌注化疗组65例患者74个病灶仅接受支气管动脉内GP方案化疗2～4个周期,比较两组患者的疗效和不良反应发生率。结果联合治疗组和灌注化疗组1、3、6、12个月的总缓解率分别为8.8%、56.1%、63.6%、84.0%和2.7%、21.%、41.9%、45.1%,组间差异有统计学意义(P<0.01或P<0.05)、联合治疗组和灌注化疗组1年累计生存率分别为91%和65%,中位生存时间分别为533 d和422 d,差异有统计学意义(,P<0.05)。CT导引下^(125)Ⅰ粒子植入的主要并发症为气胸、咯血、放射性粒子游走和胸腔积血,灌注化疗主要的不良反应为骨髓抑制和胃肠道反应等,患者可以耐受,联合治疗组和灌注化疗组患者各化疗不良反应的总发生率差异均无统计学意义(P>0.05)。结论 CT导引下^(125)Ⅰ粒子组织间植入联合经支气管动脉灌注化疗治疗肺癌是一种安全、有效、微创的治疗方法。

Objective To evaluated the efficacy and safety of CT- guided pereutaneous 125I seed implantation combined with bronchial arterial infusion chemotherapy for advanced lung cancers. Methods A total of 108 patients with advanced lung cancer were enrolled in this study. The patients were randomly divided into study group （n = 43, 57 lesions） and control group （n = 65, 74 lesions）. CT-guided pereutaneous 125I seed implantation combined with bronchial arterial infusion chemotherapy of GP scheme （2 ~ 4 cycles） was carried out in the patients of study group, while only bronchial arterial infusion chemotherapy of GP scheme （2 ~ 4 cycles） was employed in the patients of control group. The clinical efficacy and the adverse effects were recorded, and the results were compared between the two groups. Results The overall response rates at 1, 3, 6 and 12 months after the treatment in the study group were 8.8%, 56.1%, 63.6% and 84.0% respectively, and in the control group those were 2.7%, 21.%, 41.9% and 45.1% respectively. The difference in the overall response rate between the two groups was statistically significant （P 〈 0.05）. The one-year survival rates of the study group and the control group were 91% and 65%, respectively. The median survival time was 533 days in the study group and 422 days in the control group. The difference between the two groups was significant （P 〈 0.05）. The main complications related to CT- guided percutaneous 125I seed implantation included pneumothorax, hemoptysis, seed migration andhemathorax. The main adverse effects due to chemotherapy were arrest of bone marrow and gastrointestinal toxic reactions which weretolerated by the patients. No significant difference in the occurrence of adverse effects existed between the two groups （P 〉 0.05）. Conclusion CT-guided percutaneous ^125I seed implantation combined with bronchial arterial infusion chemotherapy is a safe, effective and minimally-invasive treatment for advanced lung cancers.