Clinical study of interventional preoperative bronchial artery infusion chemotherapy combined with surgical resection for advanced non-small cell lung cancer

Objective： How to improve the postoperative 5-year survival rate for lung cancer and to give more patients a chance of surgery have become research hotspots. The aim of this research is to evaluate the clinical and pathohistological responses and effects of preoperative bronchial artery infusion （BAI） chemotherapy in patients with locally advanced （stage Ⅲ） non-small cell lung cancer （NSCLC）. Methods： A total of 92 patients with locally advanced NSCLC were randomly divided into two groups. BAI group received BAI chemotherapy for 2 cycles before surgical resection. Surgery group received operation only. The complete resection rate and clinical response were compared between the two groups. Results： In the BAI group, the clinical response rate and the pathohistological response rate were 68.3% and 51.3%, respectively. The complete resection rate in the BAI group was 89.7%, which was significantly higher than that in the surgery group （72.5%） （P 〈 0.05）. The 1- and 2-year survival rate was 100.0% and 80.6% in the BAI group, and 94.1% and 60.0% in the surgery group. Conclusion： BAI neoadjuvant chemotherapy is safe and effective, which has a good clinical and pathohistological response. It might increase the complete resection rate of the tumor and improve the long term survival rate of stage Ⅲ NSCLC patients.

The effects on surgery and preoperative patients with non-small cell lung cancer by preoperative bronchial artery infusion chemotherapy

Objective： To study the efficiency, safety and feasibility of preoperative bronchial artery infusion （BAI） chemotherapy on operation in patients with locally advanced （stage Ⅲ） non-small cell lung cancer （NSCLC）. Methods： 92 cases with locally advanced NSCLC patients were randomly divided into two groups： （1） BAI chemotherapy group： 39 cases were received BAI chemotherapy for 2 courses and followed surgery; （2） surgery alone group： 51 cases were treated by operation alone. The complete resection rate and preoperative complications were compared between these two groups. Results： In BAI chemotherapy group, the rate of clinical efficiency was 68.3% with slight toxicity. In BAI chemotherapy group the surgery complete resection rate was 89.7%, which was significantly higher than that in surgery alone group （72.5%, P 〈 0.05）. No significant differences of blood loss, operative complications and mortality were observed between these two groups. Conclusion： BAI neoadjuvant chemotherapy was safe and effective, which can increase the complete resection rate of the tumor and did not increase the operative complications and mortality.

Effect of preoperative bronchial artery infusion chemotherapy on the tumor malignancy of patients with stage IIIA non-small cell lung cancer

Objective:To investigate the effect of preoperative bronchial artery infusion chemotherapy on the tumor malignancy of patients with stage IIIA non-small cell lung cancer.Methods:99 patients with stage IIIA non-small cell lung cancer who underwent surgical treatment in our hospital between January 2015 and August 2018 were chosen as the research subjects, and the preoperative adjuvant therapies were reviewed and used to divide them into the control group (n=51) who received conventional neoadjuvant chemotherapy and the study group (n=48) who received neoadjuvant chemotherapy combined with bronchial artery infusion chemotherapy. The differences in the expression levels of NSCLC-related proliferation, invasion and apoptosis genes in intraoperative lesion tissues were compared between the two groups.Results: NSCLC-related proliferation genes CD137L, dlk1, EZH2 and WT1 mRNA expression in lesion tissues of study group were lower than those of control group whereas DCLAK11 mRNA expression was higher than that of control group;NSCLC-related invasion genes ALX1, periostin and RAC1 mRNA expression were lower than those of control group whereas DAL-1 mRNA expression was higher than that of control group;NSCLC-related apoptosis genes Survivin, Livin, bcl-2 and Bag-1 mRNA expression were lower than those of control group.Conclusion: Preoperative bronchial artery infusion chemotherapy can further inhibit the malignant biological behaviors of cancer cells in patients with stage IIIA NSCLC.

Effect of bronchial arterial infusion chemotherapy combined with elemene on the malignant lesion molecules and systemic immune response in patients with advanced lung cancer

Objective:To study the effect of bronchial arterial infusion chemotherapy combined with elemene on the malignant lesion molecules and systemic immune response in patients with advanced lung cancer.Methods:A total of 78 patients diagnosed with advanced lung cancer in our hospital between April 2013 and March 2016 were selected as research subjects and randomly divided into observation group who accepted bronchial arterial infusion chemotherapy combined with elemene therapy and control group who accepted bronchial arterial infusion chemotherapy. After 4 weeks of treatment, tumor lesions were collected to determine the expression of proliferation and invasion molecule, and serum was collected to determine the levels of immune cell-related cytokines.Results:After 4 weeks of treatment, TCF3, Livin, Bcl-2, HOXB7, PTTG1, Vimentin, E-cadherin, Rap2a andβ-catenin protein expression in tumor lesions of observation group were significantly lower than those of control group;serum IFN-γ level of observation group was significantly higher than that of control group while IL-4, IL-9, IL-10 and TGF-β levels were significantly lower than those of control group.Conclusions:Bronchial arterial infusion chemotherapy combined with elemene can inhibit the expression of proliferation and invasion of molecules in tumor lesions and improve the systemic anti-tumor immune response in patients with advanced lung cancer.

LONG TERM RESULTS OF BRONCHIAL ARTERIAL INFUSION WITHCHEMOTHERAPEUTIC AGENTS PLUS RADIATION THERAPYIN THE TERATMENT OF LOCALLY ADVANCEDNON SMALL CELL LUNG CANCER

Objective: To evaluate the efficacy of the bronchial arterial infusion (BAI) plus radiation therapy (RT) for locally advanced non-small-cell lung cancer (NSCLC). Methods: 79 patients with locally advanced NSCLC were divided randomly into two groups. In the RT group, the radiation was given by 8Mv X-ray or 18Mv X-ray with 2Gy/fraction, 5 fraction per week with a total dose of 60Gy～65Gy/6～7 weeks. In the BAI+RT group, the radiation was given as RT group. Bronchial arterial infusion was performed before RT. The regimen consisted of DDP 100 mg/m2, MMC 10 mg, and 5-Fu 1000 mg. Each patient received two or three cycles. Results: The overall response rates were 80.5% in BAI+RT group and 50% in RT group. The 1-, 3-, 5-year survival rates in the BAI+RT group were significantly improved when compared to the RT group, being 87.8% vs 36.8%, 39.0% vs 7.9%, and 17.1% vs 2.6% respectively. The median time of radiation treatment to recurrence of primary lesion was 11 months in the BAI+RT group and 5 months in the RT group (P<0.05). The acute reactions were increased but acceptable in BAI+RT group, and the radiation treatments were able to be completed without any break. The late reactions were similar in both groups. Conclusion: The survival rates of patients with locally advanced NSCLC can be improved by BAI+RT without increasing any complication.

支气管动脉灌注联合载药微球化疗栓塞术治疗不可切除性肺癌合并咯血的临床效果观察

目的研究支气管动脉灌注联合载药微球化疗栓塞术治疗不可切除性肺癌合并咯血的临床效果。方法选取2022年2月至2024年2月我院治疗的160例不可切除性肺癌合并咯血患者为研究对象,采用随机数字表法分为对照组和观察组各80例。对照组采用支气管动脉灌注化疗栓塞术治疗,观察组在对照组基础上联合载药微球化疗栓塞术治疗,均治疗3个月,比较两组患者的临床疗效、咯血量及并发症发生率。结果观察组治疗总有效率为92.50%,高于对照组的81.25%,差异有统计学意义(P<0.05);治疗后3、5、7 d,观察组咯血量较对照组少,差异有统计学意义(P<0.05);观察组并发症发生率为5.00%,低于对照组的17.50%,差异有统计学意义(P<0.05)。结论支气管动脉灌注联合载药微球化疗栓塞术治疗不可切除性肺癌合并咯血的临床效果较好,可显著减少患者咯血量,降低并发症发生率。

Achievable complete remission of advanced non-small-cell lung cancer: Case report and review of the literature

Surgery is the first choice of treatment for patients with non-small-cell lung cancer(NSCLC), but few patients can be treated surgically because of either advanced disease or poor pulmonary function. Other therapies include radiotherapy and chemotherapy, as well as complementary and alternative therapies, usually with disappointing results. Bronchial artery infusion(BAI) is a manageable and effective method for treating advanced NSCLC. Outcome is good by BAI due to its repeatability and low toxicity. Icotinib hydrochloride is a newly developed and highly specific epidermal growth factor receptor(EGFR) tyrosine kinase inhibitor and has been safely and efficiently used to treat advanced NSCLC. We herein report a 73-year-old patient with chronic cough, who was diagnosed with advanced NSCLC with the EGFR mutation of L858 R substitution in exon 21, and treated with the combination of oral icotinib and BAI chemotherapy as the first-line therapy, which resulted in a satisfactory clinical outcome. Complete remission of advanced NSCLC can be achieved using the combination of oral icotinib and BAI chemotherapy.

Adenovirus-mediated wild-type p53 gene transfer in combination with bronchial arterial infusion for treatment of advanced non-small-cell lung cancer,one year follow-up

Objective： In the present study, we have examined the safety and efficacy of recombinant adenovirus encoding human p53 tumor suppressor gene （rAd-p53） injection in patients with advanced non-small-cell lung cancer （NSCLC） in the combination with the therapy of bronchial arterial infusion （BAI）. Methods： A total of 58 patients with advanced NSCLC were enrolled in a non-randomized, two-armed clinical trial. Of which, 19 received a combination treatment of BAI and rAd-p53 （the combo group）, while the remaining 39 were treated with only BAI （the control group）. Patients were followed up for 12 months, with safety and local response evaluated by the National Cancer lnstitute＇s Common Toxicity Criteria and response evaluation criteria in solid tumor （RECIST）, respectively. Time to progression （TTP） and survival rates were also analyzed by Kaplan-Meier method. Results In the combo group, 19 patients received a total of 49 injections ofrAd-p53 and 46 times of BAI, respectively, while 39 patients in the control group received a total of 113 times of BAI. The combination treatment was found to have less adverse events such as anorexia, nausea and emesis, pain, and leucopenia （P〈0.05） but more arthralgia, fever, influenza-like symptom, and myalgia （P〈0.05）, compared with the control group. The overall response rates （complete response （CR）＋partial response （PR）） were 47.3% and 38.4% for the combo group and the control group, respectively （P〉0.05）. Patients in the combo group had a longer TTP than those in the control group （a median 7.75 vs 5.5 months, P-0.018）. However, the combination treatment did not lead to better survival, with survival rates at 3, 6, and 12 months in the combo group being 94.74%, 89.47%, and 52.63%, respectively, com- pared with 92.31%, 69.23%, and 38.83% in the control group （P=0.224）. Conclusion： Our results show that the combination of rAd-p53 and BAI was well tolerated in patients with NSCLC and may have improved the quality of life and delayed the disease progression. A further study to better determine the efficacy of this combination therapy is warranted.

支气管动脉灌注化疗联合栓塞术对非小细胞肺癌患者的影响研究

分析了采用支气管动脉灌注化疗联合栓塞术治疗非小细胞肺癌的应用价值。选取贵州医科大学附属白云医院2019年1月—2019年12月收治的90例非小细胞肺癌患者为研究对象,分为对比组和研究组。对比组(n=45)接受支气管动脉灌注治疗,研究组(n=45)在对比组基础上联合应用栓塞术。观察两组患者的临床治疗总有效率、并发症发生率、不良反应情况。患者接受临床远期疗效的对比,包括两组患者1、2、3年的生存率比较分析,同时比较两组的血清肿瘤标志物、血清炎性因子、T淋巴细胞亚群比较。不仅如此,还需要将两组患者的临床治疗总依从率进行对比分析。研究发现,支气管动脉灌注化疗联合栓塞术在非小细胞肺癌患者中的应用,实现了患者治疗总有效率的提升,并且有效降低了患者并发症发生率与不良反应问题的出现,患者的生存率得到了保证,血清炎性因子改善明显,T淋巴细胞亚群显著提升,对于患者治疗总依从率提升也有一定的促进意义。

非小细胞肺癌的介入治疗现状

肺癌是我国最常见的恶性肿瘤之一。据2010年我国卫生统计年鉴显示,2005年肺癌死亡率占我国恶性肿瘤死亡率的第1位。其中非小细胞肺癌(non-small-cell lung cancer,NSCLC)约占所有肺癌的85%,大部分患者确诊时已为中晚期,已丧失手术根治切除的机会,5年生存率在15%左右。介入治疗因其操作简单、局部疗效好、不良反应小、可重复性好等特点,目前已成为中晚期NSCLC非手术治疗的重要方法,并已广泛应用于临床。本文对NSCLC的介人治疗现状及进展作一综述。

术前支气管动脉灌注化疗治疗Ⅲa(N_2)期非小细胞肺癌

目的探讨术前支气管动脉灌注(BAI)化疗在Ⅲa(N2)期非小细胞肺癌(NSCLC)治疗中的临床应用价值。方法临床确诊的Ⅲa(N2)期非小细胞肺癌186例,随机分为观察组和对照组,每组93例。观察组患者在接受2次BAI后手术,对照组确诊后直接手术,观察BAI疗效,比较两组患者的手术情况和术后生存率。结果观察组的临床和组织学有效率分别为80.6%和83.9%,TNM分期下降50.53%,不良反应轻微;观察组根治性手术切除率为93.4%,显著高于对照组的72.0%,差异有统计学意义(P<0.05);术中出血量和术后并发症两组间无差别;观察组与对照组1、3、5年生存率分别为97.8%、64.8%、36.3%和89.3%、50.5%、18.3%,两组间差异有显著统计学意义(P<0.01)。结论术前BAI可获得较好的临床和组织学疗效,并能提高Ⅲa(N2)期NSCLC的根治性手术切除率和术后生存率,值得临床推广应用。

肺癌支气管动脉灌注化疗引起食管支气管瘘

作者自1986～1994年间对1200例中晚期肺癌病人,径4000余人次的支气管动脉灌注(BAD 抗癌药物治疗,发生食管炎7例,占7/4000(1.75‰);食管支气管瘘3例,占3/4000(0.75‰),这三例中1例经手术修补成活,2例死亡。作者提出发生食管支气管瘘的主要原因是左、右支气管动脉均有分支供血食管,当较高浓度的5Fu,阿霉素或丝裂霉素灌注治疗后,引起食管炎、溃疡、直至穿孔,瘘管形成。并对这一并发症的诊断与鉴别诊断、治疗和预防作较详细的讨论。

中心型非小细胞肺癌术前支气管动脉灌注化疗疗效分析

目的 评价非小细胞肺癌 (NSCLC)术前支气管动脉灌注化疗 (BAI)近期疗效。方法 经影像学判断手术切除难度较大 ,或不能手术切除的中心型NSCLC患者 2 0例行前瞻性术前BAI。BAI后行手术切除。结果 BAI治疗前后TNM分类改变 5例 ,其中N下降 1例 ,5例均有T改变 ;临床分期下降 2例。PR 8例 ,缓解率为 40 % ,其中鳞癌 6例 ,腺癌 2例 ;NC 12例 ,其中腺癌 1例 ,其余为鳞癌。BAI前后肺不张改善的 9/ 12例 ( 75 % ) ;与周围组织关系密切或受侵改善的 6 / 15例 ( 37 5 % ) ;纵隔淋巴结肿大缩小的 12 / 18例 ( 6 6 6 7% )。结论 BAI作为NSCLC ,尤其是鳞癌的术前辅助治疗 ,具有一定的近期疗效 ,与其它辅助治疗具有同样重要的临床意义 ,是一种特殊的NSCLC新辅助化疗形式。BAI后CT扫描尚不能完全反应残存肿瘤及肿瘤坏死、纤维化等组织学方面的改变 ,具有局限性。CYFRA2 1

支气管动脉灌注化疗加体外照射治疗晚期肺癌37例

１９９０年２月至１９９３年１２月，选择性支气管动脉灌注化疗（ＢＡＩ）加体外放射治疗（ＲＴ）３７例不能手术的晚期肺癌（Ⅲ期３３例，Ⅳ期４例），经治疗９０．１％的病例症状消失或减轻，近期有效率（ＣＲ＋ＰＲ）：单用ＢＡＩ疗法为７０．３％，ＢＡＩ＋ＲＴ为８９．２％。随访至１９９４年５月，生存１２例，生存期４～４８个月，死亡２５例，其中位生存期１２个月，平均１４．４个月。全组病例０．５、１、２、３年生存率分别为９４．４％、６１．３％、３７．５％及６．３％。对不能手术的晚期肺癌，ＢＡＩ合并放疗是一种选择的治疗方法。

支气管动脉内灌注药物治疗老年肺癌疗效及影响因素分析

目的 探讨支气管动脉内灌注化疗药物 (BAI)治疗老年肺癌的疗效及影响疗效的因素。方法 采用 Seldinger法经皮股动脉穿刺插管行选择性支气管动脉造影 ,找到靶动脉后按 3种药物配合分别注入化疗药物 ,观察疗效及影响疗效的因素。结果 1本组1 0 1例老年肺癌总有效率为 90 .1 0 % ,中心型肺癌的有效率为 81 .80 % ,周围型肺癌为 65.71 %。 2有肺外淋巴结转移者有效率为70 .2 1 % ,无转移者为 61 .1 1 %。 3不同化疗药物配合对疗效的影响分别为 56.0 9% ,44.1 4 % ,52 .88%。 4肿瘤供血有侧支循环形成者疗效为 85.70 % ,无侧支循环者为 65.30 %。 5肿瘤内新生血管的影响 ,少血管型为 45.81 % ,中血管型为 65.63% ,多血管型为 75.56%。结论 选择性支气管动脉内注入化疗药物治疗老年肺癌的疗效优于静脉滴注化疗 ;其疗效与癌肿发生部位、组织类型及癌肿供血等因素有关 。

中晚期非小细胞肺癌支气管动脉灌注化疗的Meta分析

背景 支气管动脉灌注介入治疗能否真正给中晚期非小细胞肺癌患者带来益处仍存在争议。目的评价肺癌的介入治疗在临床中晚期非小细胞肺癌的反应率、生活质量、生存期中的意义。检索策略 通过CBM disc、MEDLINE等数据库全面检索国内外已发表和未发表的相关文献。选择标准 支气管动脉灌注化疗与以铂类为基础的全身静脉化疗疗效比较的随机对照试验(RCT)或半随机对照试验(QRCT)。资料收集和分析 由2位评价者按照上述检索策略收集文献,排除不符合选择标准的试验,主要对反应率进行Meta分析。结果 支气管动脉灌注化疗与以铂类为基础的全身静脉化疗相比,治疗非小细胞肺癌的反应率提高11％,但无统计学意义。结论 目前仍不能把支气管动脉灌注介入治疗作为一种与手术、化疗或放疗并行治疗中晚期非小细胞肺癌的基本模式。有必要开展更多设计实施良好的临床随机对照试验以解决这一争议。

肢体循环阻断在肺癌支气管动脉局部强化治疗的临床应用(附70例报告)

肺癌70例,均经支气管动脉内灌注地塞米松10mg,阿霉素30～60mg,丝裂霉素10～20mg,顺铂30～60mg;注药时,另外三个肢体加压,阻断循环。注药后2～4周复查,总有效率为92.8％。仅10％的病例白细胞下降低于4.0×10~9/L。此法可望提高疗效。

支气管动脉灌注紫杉醇联合全身化疗治疗晚期非小细胞肺癌

目的 观察选择性经支气管动脉灌注紫杉醇 (泰素 )及卡铂并联合紫杉醇全身化疗治疗晚期非小细胞肺癌 (NSCLC)的疗效及不良反应。方法 对 5 7例晚期NSCLC患者经支气管动脉注入紫杉醇和卡铂 ,同时予紫杉醇全身化疗 ,每例均完成 2～ 3周期后评价其疗效及不良反应。结果 5 7例中完全缓解 (CR) 6例 ,部分缓解 (PR) 2 8例 ,总有效率 5 9.6 %。主要不良反应为骨髓抑制、胃肠道反应、脱发等 ,不良反应多为Ⅰ～Ⅱ度。结论 经支气管动脉灌注紫杉醇和卡铂并联合紫杉醇全身化疗是治疗晚期非小细胞肺癌的一种有疗效好。

介入治疗中晚期肺癌的疗效分析

目的：回顾分析支气管动脉灌注治疗中晚期肺癌的临床疗效及影响疗效的因素，提出合理的应用介入方法 治疗中晚期肺癌以获得更好的疗效。方法：收集介入治疗２００例肺癌，用Ｓｅｌｄｉｎｇｅｒ法插管，找到患侧支气管动脉开口，造 影证实后，注入抗癌药物。结果：２００例病人中，完全缓解４２例，部分缓解ｌ０９例，稳定３７例，病变进展１２例，总有效率为 ７５．５％。结论：介入治疗中晚期肺癌是一种主要有效方法。它能延长病人的生存期和提高病人的生活质量。但由于存 在一些影响该治疗疗效的因素，所以开展以介入治疗为主的综合治疗将可获得更好的疗效。

支气管动脉灌注联合全身化疗治疗晚期非小细胞肺癌

目的观察选择性支气管动脉灌注吉西他滨、奥沙利铂（GEMOX方案）并联合吉西他滨静脉滴注化疗治疗晚期非小细胞肺癌（NSCLC）的疗效和不良反应。方法对38例晚期NSCLC患者第1 d经支气管动脉注入吉西他滨、奥沙利铂,第8 d予吉西他滨静脉滴注化疗,21~28 d为一个周期,完成2~3周期后评价其疗效及不良反应。结果 38例中完全缓解（CR）0例,部分缓解（PR）23例,总有效率60.5%。主要不良反应为骨髓抑制、消化道反应等,不良反应多为Ⅰ~Ⅱ度。结论基于GE-MOX方案的支气管动脉灌注联合全身化疗治疗晚期非小细胞肺癌疗效好、不良反应可耐受。