BAI新辅助化疗联合手术治疗老年局部晚期非小细胞肺癌

Clinical Study of Interventional Neoadjuvant Chemotherapy Combining with Surgery Resection to the Aged with Locally Advanced Non-Small-Cell Lung Cancer

目的 观察BAI(支气管动脉灌注 )新辅助化疗治疗老年局部晚期 (Ⅲ期 )非小细胞肺癌(NSCLC)的临床和病理组织学疗效以及对提高手术切除率的作用。方法 78例老年局部晚期NSCLC患者随机分为 2组 :(1)BAI化疗组 ,先给予 1～ 2个疗程的BAI化疗后进行手术治疗 ;(2 )单纯手术组 ,确诊后直接手术。结果 BAI化疗组的临床有效率和病理组织学有效率均为 5 0 .0 %。完成 2个疗程BAI化疗患者的临床和组织学有效率均高于 1个疗程的患者 (P <0 .0 5 )。但以影像学变化为判定标准的临床疗效与组织学疗效并不完全一致。BAI化疗组的手术切除率 (84 .2 % )和完全性切除率 (5 5 .3% )均显著高于单纯手术组 (分别为 6 0 .0 %和 30 .0 % ,P <0 .0 5 )。结论 老年局部晚期NSCLC进行BAI新辅助化疗可获得良好的临床和病理组织学疗效 ,且以 2个疗程BAI化疗的疗效为佳。BAI新辅助化疗可提高老年局部晚期NSCLC的手术切除率和完全性切除率。

Objective To observe the clinical and pathohistological response and effect of BAI (bronchial artery infusion) neoadjuvant chemotherapy on surgery resection rate in the aged with locally advanced (stage Ⅲ) non-small-cell lung cancer(NSCLC). Methods 78 cases of the aged with locally advanced NSCLC were randomly divided into two groups: (1) BAI chemotherapy group received BAI chemotherapy in 1～2 courses and followed surgery;(2) surgery alone group was treated by operation alone. Results In BAI chemotherapy group, both rates of clinical response and pathohistological response were 50.0%. Both rates of clinical response and pathohistological response were significantly higher in patients who had received two courses than those received one course BAI chemotherapy ( 66.7% vs. 21.4% and 62.5% vs. 12.5% respectively, P< 0.05). However, the clinical response based on changes of CT image was not completely consistent with pathohistological response on tumor specimen. Surgery resection rate was 84.2%, and complete resection rate was 55.3% in BAI chemotherapy group, which were markedly higher than those in surgery alone group ( 60.0% and 30.0% respectively, P< 0.05). Conclusion BAI neoadjuvant chemotherapy has a good clinical and pathohistological response in the aged with locally advanced NSCLC. Effect of two courses is in better than that of one course BAI chemotherapy. BAI neoadjuvant chemotherapy can improve surgery resection rate,especially complete resection rate in the aged with locally advanced NSCLC.