CT引导射频消融同期瘤内化疗治疗Ⅲ期非小细胞肺癌的临床研究

Clinical study of CT-guided radiofrequency ablation plus intratumoral chemotherapy for patients with stage Ⅲ non-small cell lung cancer

目的 探讨CT引导下射频消融同时进行瘤内化疗治疗Ⅲ期非小细胞肺癌（NSCLC）的疗效及安全性.方法 2014年2月至2015年5月,选取本院收治因高龄而未接受全身化疗的38例Ⅲ期NSCLC患者,采用分层随机方法将其分为实验组和对照组,每组19例.实验组于CT引导射频消融后给予瘤内化疗药物洛铂,对照组仅接受CT引导射频消融治疗,观察两组患者不良反应、术后Kamofsky功能状态（KPS）评分、1年生存率及近期疗效.结果 38例患者均顺利完成治疗.实验组患者治疗后3个月有效率（89.5％∶63.2％）及治疗后6个月有效率（78.9％∶52.6％）差异均无统计学意义（P=0.124;P =0.170）.实验组与对照组KPS评分改善率分别为42.1％ （8/19）和31.6％ （6/19）、稳定率分别为52.6％ （10/19）和52.6％ （10/19）、恶化率分别为5.3％ （1/19）和15.8％ （3/19）,差异均无统计学意义（P =0.737;P=1.000;P=0.290）.实验组患者的1年生存率高于对照组（89.5％∶73.7％）,差异有统计学意义（x2=5.573,P=0.034）.实验组患者3级内疼痛（31.6％∶42.1％）、低热（21.1％∶26.3％）、气胸（31.6％∶42.1％）、消化道反应（15.8％∶31.6％）、骨髓抑制（5.3％∶15.8％）发生率低于对照组,但差异均无统计学意义（P =0.501;P=0.703;P=0.501;P=0.252;P =0.290）.结论 射频消融联合瘤内化疗治疗Ⅲ期NSCLC患者可提高短期生存率,且并未增加不良反应,长期生存率方面尚有待进一步跟踪随访.

Objective To explore the clinical efficacy and safety of CT-guided radiofrequency ablation plus intratumoral chemotherapy in patients with stage Ⅲ non-small cell lung cancer （NSCLC）.Methods From February 2014 to May 2015,38 patients with stage Ⅲ NSCLC who did not receive systematic chemotherapy due to advanced age were selected in our hospital.The patients were divided into experimental group （n =19） and control group （n =19） by stratified random method.The patients in experimental group received CT-guided radiofrequency ablation plus Lobaplatin intratumoral chemotherapy,and the patients in control group only received CT-guided radiofrequency ablation.The adverse events,Karnofsky performance system （KPS） scores,1-year overall survival rates and short-term curative effects of patients in the two groups were observed.Results All 38 patients completed the course of therapy successfully.The 3-month response rates and 6-month response rates in experimental group and control group were 89.5% vs.63.2% and 78.9% vs.52.6%,with no significant differences （P =0.124;P =0.170）.The KPS score improvement rates were 42.1% （8/19） and 31.6% （6/19） in experimental group and control group,the KPS score stable rates were 52.6% （10/19） and 52.6% （10/19） in the two groups,and the KPS score deterioration rates were 5.3% （1/19） and 15.8% （3/19） in the two groups,with no significant differences （P =0.737;P =1.000;P =0.290）.The 1-year survival rate of patients in experimental group was higher than that in control group （89.5% vs.73.7%）,with a significant difference （x2 =5.573,P =0.034）.The rates of less than or equal to grade 3 pain （31.6% vs.42.1%）,low fever （21.1% vs.26.3%）,aerothorax （31.6% vs.42.1%）,gastrointestinal reaction （15.8% vs.31.6%） and bone marrow depression （5.3% vs.15.8%） in experimental group were lower than those in control group,but the differences were not statistically significant （P =0.501;P =0.703;P =0.501;P =0.252;P =0.290）.Conclusion CT-gnided radiofrequency ablation plus intratumoral chemotherapy for stage Ⅲ NSCLC can improve short-term survival rate,and it does not increase the adverse reaction.While,the long-term overall survival rate has yet to be followed up.