术前支气管动脉灌注化疗治疗Ⅲ期非小细胞肺癌的探讨

Preoperative bronchial artery infusion chemotherapy in stage Ⅲ NSCLC

目的 评价支气管动脉灌注化疗作为术前化疗方法对Ⅲ期非小细胞肺癌的治疗效果。方法 选择临床Ⅲ期肺癌 30例 (ⅢA 2 7例 ,ⅢB 3例 ) ,予以选择性支气管动脉灌注化疗。方案为 :( 1)顺铂 ( 4 0mg/m2 )、丝裂霉素 ( 10mg/m2 )及阿霉素 ( 4 0mg/m2 )于第 1、2 9d经患侧支气管动脉注入 ;( 2 )顺铂 ( 4 0mg/m2 )第 2、30d经iv注入。记录与治疗有关的副反应 ;治疗结束后再行分期检查 ,评价疗效 ;对有手术指征者行外科治疗 ,记录手术及术后情况 ,并对切除标本进行病理学检查。结果 支气管动脉灌注化疗后临床有效率为 83.3% (CR 6例 ,PR 19例 ) ,SD 4例 ,进展 1例。外科治疗 2 9例 ,根治切除 2 5例 ,切除率为 86 .2 %。围手术期发生严重并发症 2例 ,其中 1例死亡。病理检查 :仅发现 1例为病理CR。结论 术前支气管动脉灌注化疗可有效地降低Ⅲ期NSCLC的分期 ,提高手术切除率 ,但治愈Ⅲ期NSCLC的可能性很小。该综合治疗方法的远期效果有待进一步观察。

Objective Neoadjuvant chemotherapy has become a hot topic since some studies showed that it could improve the resectability and survival of patients with stage Ⅲ non-small cell lung cancer (NSCLC).However,only half or a few more than half patients attained OR from the therapeutic modality;besides,neoadjuvant chemotherapy led to signicant associated morbidity and mortality.Bronchial artery infusion chemotherapy could achieve OR rate over 80% in advanced lung cancer.Therefore,preoperative bronchial artery infusion chemotherapy for stage Ⅲ NSCLC would be investigated.Methods Thirty patients with local advanced NSCLC (27 with stage Ⅲ A and 3 with stage Ⅲ B) were enrolled into the study.The regimen consisted of (1) cisplatin (40mg/m 2),mitomycin(10mg/m 2) and doxorubicin(40mg/m 2) which were given through bronchial artery on days 1 and 29,(2) cisplatin(40mg/m 2) was given intravenously on days 2 and 30.(3)surgical resection was performed on approximately day 45.Results Six patients (20%) had complete response and 19 patients (63.3%) had partial response to the intervention chemotherapy.But 4 patients were stable and 1 was progressive.29 patients underwent thoracotomy and 25 patients one out of this 2 patients had a radical resection.Only one patient showed no evidence of tumor histologically.2 patietns had serious complication and died eventually.Conclusion Preoperative bronchial artery infusion chemotherapy can contribute to high response rate and improve resectability in stage Ⅲ NSCLC.Long-term survival rate of stage Ⅲ NSCLC patients after this approach can be justified by further trials.