老年Ⅲ期非小细胞肺癌介入性新辅助化疗的应用

Application of Interventional Neoadjuvant Chemotherapy to The Aged with Non-Small-Cell Lung Cancer Stage Ⅲ

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摘要 [目的]观察介入性(支气管动脉灌注,BAI)新辅助化疗治疗老年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]38例老年Ⅲ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化疗组化疗的临床有效率为52.6%(10/19),病理组织学有效率50.0%(9/18).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＜0.05).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(94.7%)和完全性切除率(63.2%)均显著高于单纯手术组(分别为63.2%和31.6%,P＜0.05).[结论]老年Ⅲ期NSCLC进行介入性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.介入性新辅助化疗可提高老年Ⅲ期NSCLC的手术切除率和完全性切除率. To observe the clinical and pathohistological response and effect of interventional(bronchial artery infusion,BAI)neoadjuvant chemotherapy on surgery resection rate in the aged with non-small-cell lung cancer(NSCLC)stageⅢ.Thirty-six cases of the aged with NSCLC stageⅢwere randomly allocated into two groups:(1)BAI chemotherapy group received1~2courses BAI chemotherapy and followed surgery;(2)surgery alone group were treated by operation alone.In BAI chemotherapy group,the rates of clinical response and pathohistological response were52.6%(10/19)and50.0%(9/18)respectively.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%vs28.6%and66.7%vs16.7%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 was94.4%,and complete resection rate was61.1%in BAI chemotherapy group,which were markedly higher than those in surgery alone group(66.7%and33.3%respectively,P<0.05).[Conclusions]Interventional neoadjuvant chemotherapy has a good clinical and pathohistological response in the aged with NSCLC stageⅢ.Effect of two courses is better than that of one course BAI chemotherapy.Interventional neoadjuvant chemotherapy can improve surgery resection rate,especially complete resection rate in the aged with NSCLC stageⅢ.