经导管动脉化疗栓塞联合经皮射频消融治疗中央型非小细胞肺癌

TACE combined with percutaneous radio-frequency ablation for central non-small cell lung cancer

目的探讨TACE联合经皮射频消融(PRFA)治疗中央型非小细胞肺癌(CNSCLC)的临床疗效及其安全性。方法回顾性分析41例不可手术切除的中晚期CNSCLC患者(共50个病灶),均接受肿瘤供血动脉TACE治疗(化疗方案:吉西他滨1 000mg+顺铂90mg;栓塞材料:Embosphere微球),并于术后5天接受PRFA治疗肿瘤。术后以增强CT随访观察肿瘤大小及其强化情况,并根据改良实体肿瘤疗效评价标准评价联合治疗效果,计算术后3、6、12个月的客观有效率(ORR)。通过Kaplan-Meier生存分析获得患者术后无进展生存时间(PFS)。观察并记录术后并发症情况。结果对所有患者均成功完成TACE及PRFA治疗。术后3、6、12个月ORR分别为92.68%(38/41)、78.05%(32/41)和68.29%(28/41)。患者中位PFS为14.8个月。32例发生术后并发症,包括胸疼13例、气胸8例、少量咯血6例、血胸3例、喉返神经损伤1例、胸膜反应1例,均较轻微,可自行缓解或经对症处理后好转,未出现脊髓损伤、大咯血及大量血气胸等严重并发症。结论 TACE联合PFRA为治疗中晚期CNSCLC的有效方法,且安全性较高。

Objective To explore the clinical efficacy and safety of TACE combined with percutaneous radio-frequency ablation(PRFA)in treatment of central non-small cell lung cancer(CNSCLC).Methods Data of 41 patients(50 lesions)with unresectable CNSCLC in middle and advanced stage were analyzed retrospectively.All patients were treated with PRFA 5 days after TACE(chemotherapy regiments:Gemcitabine 1 000 mg+cisplatin 90 mg,embolic material:Embosphere microspheres).The size and reinforcement of tumor were observed with contrast-enhanced CT after treatment.In addition,the efficacy of combination was evalated with modified response evaluation criteria in solid tumors(mRecist)criterion.The objective response rate(ORR)at 3,6,and 12 month after treatment was calculated.The progression-free survival(PFS)was obtained by Kaplan-Meier survival analysis.And the postoperative complications were observed and recorded.Results TACE and PRFA were successfully completed in all patients.ORR at 3,6 and 12 month was 92.68%(38/41),78.05%(32/41)and 68.29%(28/41),respectively.The median PFS was 14.8 months.Complications occurred in 32 patients,including 13 cases of chest pain,8 cases of pneumothorax,6 cases of hemoptysis,3 cases of hemothorax,1 case of transient laryngeal recurrent nerve damage and 1 case of pleural reaction.All symptoms were mild and remit spontaneously or improved after symptomatic treatment.There were no serious complications such as spinal cord injury,massive hemoptysis and hemopneumothorax.Conclusion TACE combined with PRFA is an effective method for treating CNSCLC in middle and advanced stage with high security.