微波消融联合放化疗治疗Ⅲ期周围型非小细胞肺癌的临床研究

Clinical study of microwave ablation combined with radiochemotherapy in the treatment of Stage Ⅲ peripheral non-small cell lung cancer

目的：探讨微波消融联合化疗对于Ⅲ期周围型非小细胞肺癌（NSCLC）治疗的疗效和并发症发生情况。方法采用随机对照研究，将2009年6月至2012年12月我科收治的102例Ⅲ期周围型NSCLC （T1～4N0～3M0）患者，根据采取的主要治疗方法分为两组：（1）对照组：47例，应用顺铂联合多西他赛或吉西他滨方案化疗及常规放疗；（2）微波消融联合放化疗组（联合组）55例，患者于微波消融术后1周给予同对照组相同的方案化疗。比较两组患者的疗效，1、2、3年的生存率，并观察两组的毒副反应。结果联合组和对照组的有效率分别为31.8%和28.9%（P＞0.05），局部控制率分别为79.5%和57.8%（P＜0.05）。联合组和对照组的1、2、3年生存率分别为49.1%和40.4%（P＝0.654），38.2%和17%（P＝0.032），25.5%和8.5%（P＝0.002）。联合组的主要并发症为气胸、胸腔积液、咯血等，未发生术中和围手术期死亡。对照组的主要并发症为骨髓抑制、胃肠道反应等。结论微波消融联合化疗治疗Ⅲ期周围型NSCLC具有协同作用，在疾病控制率和延长患者的生存期方面优于单纯化疗，而且不良反应较少，这为晚期NSCLC的治疗提供了一条新的有效方法。

Objective To investigate the clinical efficacy and safety of microwave ablation （MWA） combined with radiochemotherapy for the treatment of stageⅢ peripheral non-small cell lung cancer （NSCLC）.Methods102 patients with stageⅢ peripheral NSCLC （T1-4N0-3M0） with different treatments between 2009.6 and 2012.12 in our department were divided randomly into two groups： （1）The control group of 47 patients, application of cisplatin combined with docetaxel or gemcitabine chemotherapy and routine radiotherapy; （2）Microwave ablation combined with radiochemotherapy group （combined group） of 55 patients, one week after the microwave ablation to give the chemotherapy（regimen： same the chemotherapy group）. The efficacy and 1, 2 and 3-year survival rates of the two groups were compared, and the two groups were observed for toxicity.Results The clinical effects of the combined group and the control group were 31.8% and 28.9% （P〉0.05）, the local control rates were 79.5% and 57.8%（P〈0.05）. 1-, 2-, and 3-year survival rate of the combined group and the control group were 49.1%vs. 40.4%（P=0.654）, 38.2%vs. 17%（P=0.032）, 25.5%vs. 8.5%（P=0.002）. The major complications of the combined group were pneumothorax, pleural effusion, hemoptysis, etc. The intraoperative and perioperative death did not occur. The major complications of the control group included myelosuppression and gastro-intestinal reaction.ConclusionMicrowave ablation combined with radiochemotherapy for advanced peripheral NSCLC has a synergistic effect in disease control rate and prolong the survival of patients is superior to radiochemotherapy alone, and fewer adverse reactions, which provides a new and effective method for the treatment of advanced NSCLC.