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.

BRONCHIAL ARTERY CHEMOTHERAPY FOR INOPERABLE NON-SMALL-CELL LUNG CANCER

We applied low-dose cisplatin regimen delivered by an interventional method to twenty-one consecutively treated patients with inoperable NSCLC.The regimen consisted of cisplatin 50 mg/m2, mitomycin C 10 mg/m2,and 5-Fu 500 mg/m2.All patients had positive response to the treatment.The overall response rate was 76.2%(CR:23.8%,PR:52.4%).The median survival was 25.5±3.2 weeks,which was similar to those obtained by other combination chemotherapies,but the toxicity was significantly reduced. The results suggested that bronchial artery chemotherapy would give the patients with advanced NSCLC a satisfactory early results and a higher quality of life.It is advisable to select bronchial artery chemotherapy as a preoperative treatment for advanced NSCLC.

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。

支气管动脉化疗栓塞联合康艾对中晚期肺癌转化治疗的临床疗效

目的探讨通过支气管动脉灌注化疗栓塞联合康艾注射液对初始不可切除的Ⅲ期中央型非小细胞肺癌(non-small cell lung cancer,NSCLC)患者转化为根治性手术切除的临床疗效。方法选取中央型NSCLC患者36例,经支气管镜活检或经皮肺穿刺活检明确病理类型;通过颈胸部增强CT、头颅MRI、骨扫描和腹部CT检查进行临床评估及分期,确认为不可切除的Ⅲ期中央型NSCLC。36例患者均采用支气管动脉灌注化疗栓塞联合康艾注射液治疗,治疗两周期后评估能否手术切除。比较手术切除患者和不能手术切除患者的生存率和中位生存期。结果36例初始不可切除的Ⅲ期中央型NSCLC患者经过支气管动脉灌注化疗栓塞联合康艾注射液治疗后,其中可行根治性手术切除23例患者,术后给予辅助静脉化疗,不能手术切除13例继续给予静脉化疗或放疗。23例手术切除患者的中位生存期为31.2个月,1,2,3年生存率分别为78.2%、69.5%和56.5%。13例不能切除患者的中位生存期为15.6月,1,2,3年生存率分别为61.5%、38.5%和23.1%。结论通过支气管动脉化疗栓塞联合康艾注射液对初始不可切除的Ⅲ期中央型NSCLC患者转化为根治性手术切除取得了良好的临床疗效,值得大力推广。

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。

预见性针对干预联合支气管动脉栓塞术对肺癌大咯血患者生活质量的影响

目的探讨预见性针对干预联合支气管动脉栓塞术对肺癌大咯血患者生活质量的影响。方法将300例肺癌大咯血患者根据干预方式的不同分为对照组(n=150)和观察组(n=150)。两组患者均采用支气管动脉栓塞术治疗,对照组患者采取常规干预,观察组患者在对照组的基础上采取预见性针对干预。比较两组患者的生活质量、干预满意度、心理状态以及并发症发生情况。结果干预后,两组患者抑郁自评量表(SDS)、焦虑自评量表(SAS)评分均较干预前降低,且观察组患者SDS、SAS评分均低于对照组,差异均有统计学意义(P﹤0.05)。干预后,两组患者躯体功能、情绪功能、社会功能、认知功能、角色功能评分均较干预前升高,且观察组患者躯体功能、情绪功能、社会功能、认知功能、角色功能评分均高于对照组,差异均有统计学意义(P﹤0.05)。观察组患者并发症总发生率明显低于对照组,干预满意度明显高于对照组,差异均有统计学意义(P﹤0.01)。结论预见性针对干预联合支气管动脉栓塞术可缓解肺癌大咯血患者不良心理状态,降低并发症发生率,提高患者生活质量及满意度。

支气管动脉灌注-全身化疗序贯治疗中晚期非小细胞肺癌随机对照研究

背景与目的肺癌临床诊断时多为晚期,中晚期肺癌治疗效果欠佳,本研究对比分析中晚期非小细胞肺癌经支气管动脉灌注化疗、全身静脉化疗、支气管动脉灌注化疗加全身化疗序贯治疗的疗效,以期寻找中晚期非小细胞肺癌更理想的治疗方法。方法中晚期非小细胞肺癌127例,均经病理证实,按自愿及随机原则分为支气管动脉灌注化疗、全身静脉化疗与支气管动脉灌注化疗加全身化疗序贯治疗组。结果肺内原发灶有效率(CR+PR)介入治疗组,静脉化疗组,序贯治疗组分别为59.22%、30.23%、69.05%。经统计学分析,原发灶总有效率介入治疗组较静脉化疗组显著提高(P<0.01),序贯治疗组较静脉化疗组显著提高(P<0.01),介入治疗组与序贯治疗组无显著性差异(P>0.05)。肺外转移灶有效率介入治疗组,静脉化疗组,序贯治疗组分别为18.19%、53.85%、60.00%,转移灶有效率介入治疗组显著低于静脉化疗组(P<0.05),序贯治疗组较介入治疗显著提高(P<0.01),静脉化疗组与序贯治疗组无显著性差异(P>0.05)。结论支气管动脉灌注化疗加全身化疗序贯治疗既可有效控制肺内病灶又对远处转移有良好预防和控制的作用,值得进一步推广。

经支气管动脉和非支气管性体动脉栓塞治疗原发性肺癌咯血临床效果

目的评价经支气管动脉和非支气管性体动脉栓塞(BAE+NBSAE)治疗原发性肺癌所致咯血患者的安全性和有效性,探讨影响BAE+NBSAE术后无咯血时间的相关因素。方法回顾性分析兰州大学第一医院2007年7月至2018年12月采用BAE+NBSAE术治疗的38例原发性肺癌伴咯血患者临床资料。其中非小细胞肺癌30例,小细胞肺癌8例;Ⅳ期肺癌28例。手术开始前21例为大咯血(>300 mL/24 h),10例为中度咯血(<300 mL/24 h),7例为血痰。结果 38例BAE+NBSAE术均获成功。31例(81.6%)取得临床成功。术后患者总平均生存时间为141(103.7~178.3) d,总中位生存期为92(86.0~98.0) d;临床成功、失败患者中位生存期分别为92(52.7~131.3) d、21(13.3~28.7) d;临床成功、失败患者中位无咯血时间分别为87(76.4~97.6) d、10(7.4~12.6) d(P=0.001)。多因素Cox回归分析结果显示,大咯血(P=0.004)、癌性空洞(P=0.001)、肿瘤直径大(P=0.004)为BAE+NBSAE术后缩短无咯血时间独立影响因素。结论 BAE+NBSAE术控制原发性肺癌所致咯血安全有效,但患者死亡率仍很高。大咯血、癌性空洞、肿瘤直径大是BAE+NBSAE术后缩短无咯血时间的重要预测因素。

中药配合支气管动脉灌注化疗治疗非小细胞肺癌的临床观察

目的 :探讨中药配合支气管动脉灌注化疗 (BAIC)治疗肺癌的疗效。方法 :中晚期非小细胞肺癌 (NSCLC) 76例 ,随机分A、B两组。A组 39例为BAIC加中药治疗组 ,B组 37例为单纯BAIC组。观察比较两组近期疗效、远期生存率、临床主要症状变化、生存质量及外周血象变化情况。结果 :治疗后稳定加有效率 (CR +PR +NC)A、B组分别为 92 31%、70 2 7% ,组间比较差异有显著性 (P <0 0 5)。 0 5、1、2年生存率A组分别为 79 4 9%、56 4 1%、51 2 8% ;B组分别为 72 97%、51 35%、2 4 32 % ;2年生存率A组优于B组 (P <0 0 5)。在改善临床症状、卡氏评分、增加体重 ,以及对治疗后外周血象变化的改善方面 ,A组患者比B组更明显。结论 :中药配合BAIC可以提高BAIC效果。

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。

肺癌支气管动脉血供类型对介入方法及疗效的影响

目的 探讨肺癌支气管动脉血供类型与介入治疗方法及疗效的关系。方法 分析 81例肺癌共 16 5次支气管动脉造影征象 ,了解其血供特点 ;采用支气管动脉内灌注化疗 (BAI)和 /或支气管内栓塞治疗 (BAE)。结果 富血型 42例 ,较多血型 30例 ,乏血型 9例 ;BAI和 /或BAE后部分缓解 (PR) 5 0例 ,6 1.7% ,无变化 (NC) 2 2例 ,2 7.2 % ,进展(PD) 9例 ,11.1%。部分缓解中有 2 1例获二期手术切除 ,PR病人均为富血型或较多血型。并发症经治疗可痊愈。结论 BAI和 /或BAE治疗富血型和较多血型肺癌可达到满意效果 ,是安全。

肺转移瘤的血供情况与动脉灌注栓塞疗效的关系

背景与目的:介入治疗已广泛应用于原发性肺癌,而在肺转移瘤中应用尚较少,其主要原因为对肺转移瘤血供的研究较少,且分歧较大。本研究旨在探讨肺转移瘤的支气管动脉供血情况与动脉灌注栓塞疗效的关系,以提高肺转移瘤的治疗效果。方法:对33例肺转移瘤患者,行选择性支气管动脉造影,了解肿瘤的分布、血液供应情况,对少血供转移瘤给予支气管动脉灌注化疗,对富血供转移瘤给予碘油乳剂栓塞治疗。结果:33例共89个肺转移瘤在肺内分布情況:内中带63个(70.8%),外带26个(29.2%)。56个转移瘤富血供,33个转移瘤少血供。转移灶的支气管动脉供血类型与肿瘤的分布位置有关,内中带病灶以富血供为多,外带病灶以少血供或无支气管动脉供血的为多(P<0.01);肿瘤病灶的大小与支气管动脉供血的类型无明显相关性(P>0.05);肿瘤介入灌注栓塞的疗效与支气管动脉供血的类型有关,富血供栓塞组的有效率(71.4%)明显高于少血供灌注组(42.4%)(P<0.01),肝癌肺转移灶多数血供丰富,碘油沉积较好,随访中见病灶缩小明显,且病灶较稳定。结论:肺转移瘤仍主要由支气管动脉供血,支气管动脉供血丰富的转移瘤可采用支气管动脉灌注栓塞治疗。

^(125)I粒子植入联合动脉灌注化疗治疗不可切除性肺癌

目的探讨CT引导下125I粒子植入联合动脉灌注化疗治疗不可切除肺癌的价值。方法30例不可切除性肺癌患者随机分为两组。A组14例,125I粒子植入术前或后1周内行动脉灌注化疗;B组16例,单纯125I粒子植入治疗。两组患者125I粒子植入2个月后行胸部CT检查,按RECIST标准判定疗效并进行生存分析。结果30例患者全部按计划完成治疗。A组植入粒子552枚,9例行了2次动脉灌注化疗;B组共植入125I粒子603枚。CT复查显示:A组完全缓解(CR)0例,部分缓解(PR)10例,稳定(SD)4例,进展(PD)0例,治疗有效率为71.4%;B组完全缓解(CR)0例,部分缓解(PR)10例,稳定(SD)5例,进展(PD)1例,治疗有效率为62.5%。两组治疗有效率差异无统计学意义(P>0.05)。1年生存率分别为78.6%和62.5%,生存期差异有统计学意义(P<0.05)。结论125I粒子植入联合动脉灌注化疗是治疗不可切除性肺癌的一种有效方法,可显著延长患者的生存期。