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目的随着有效化疗药物及靶向药物的使用,肺癌患者的生存期显著延长,随之而来的是局部复发的患者日益多见。腔内近距离放疗(intraluminal brachytherapy,ILBT)被公认为是一种可应用于无临床手术机会的支气管恶性肿瘤患者的二线治疗方式。本试验通过随访研究以评价CT引导的高剂量率ILBT治疗复发支气管肺癌患者的近期及远期疗效及安全性。方法收集苏州大学附属第一医院2009-06-01-2015-09-30收治的15例复发支气管肺癌患者的临床特征、治疗方法、疗效及不良反应,并利用Kaplan-Meierer法进行生存分析。结果 15例复发支气管肺癌的患者均接受ILBT,均可评价疗效和不良反应。全组完全缓解(complete response,CR)2例,部分缓解(partial response,PR)11例,稳定(stable disease,SD)1例,进展(progression disease,PD)1例,总有效率(response rate,RR)86.7%(13/15),疾病控制率(CR+PR+SD)93.3%(14/15)。患者在ILBT后第1、2、4和8周末时的气促评级均显著减少,P<0.001。ILBT后的平均局部缓解期为(5.27±3.35)个月,中位局部缓解期为3.24个月,联合支气管介入治疗(P=0.013)及ILBT累积剂量>20Gy(P=0.013)可提高局部有效率。患者中位无进展生存期(progress-free survival,PFS)为9.5个月(95%CI:12.2~16.5个月),平均PFS为(15.8±14.4)个月,中位生存期(overall surrival,OS)23.0个月(95%CI:25.0~30.0个月),平均OS(28.0±17.0)个月,1、2年生存率分别为93.3%(14/15)和40.0%(6/15)。主要不良反应为支气管痉挛和咯血,其次为咳嗽、气促、乏力、恶心呕吐和骨髓抑制。结论 CT引导的ILBT治疗复发支气管肺癌是一种安全、有效的肿瘤姑息治疗方式,值得扩大样本量进一步研究。
Purpose With the use of effective chemotherapy drugs and targeted drugs, the survival of patients with lung cancer significantly prolonged, followed by the recurrence of patients is increasingly common. Intraluminal brachytherapy (ILBT) is recognized as a second-line treatment for patients with bronchial malignancies without a chance of clinical surgery. This trial was to evaluate the short-term and long-term efficacy and safety of high-dose CT-guided ILBT in the treatment of patients with recurrent bronchogenic carcinoma by follow-up study. Methods The clinical features, treatment, efficacy and adverse reactions of 15 patients with recurrent bronchogenic carcinoma were collected from the First Affiliated Hospital of Soochow University. The Kaplan-Meier method was used for survival analysis. Results All 15 patients with recurrent bronchogenic carcinoma received ILBT, which could evaluate the efficacy and adverse reactions. Two cases of complete response (CR), partial response (PR) in 11 cases, stable disease (SD) in 1 case, progression disease (PD) in 1 case and total response rate , RR) 86.7% (13/15), disease control rate (CR + PR + SD) 93.3% (14/15). Patients had significantly reduced levels of shortness of breath at the 1st, 2nd, 4th, and 8th weekend after ILBT, P <0.001. The average local remission after ILBT was (5.27 ± 3.35) months, and the median local remission was 3.24 months. The combination of bronchial intervention (P = 0.013) and the cumulative dose of ILBT> 20Gy (P = 0.013) effectiveness. The median progression-free survival (PFS) was 9.5 months (95% CI: 12.2 to 16.5 months), mean PFS was (15.8 ± 14.4) months, overall surrival OS) were 23.0 months (95% CI: 25.0-30.0 months), mean OS was (28.0 +/- 17.0) months, and 1 and 2 years survival rates were 93.3% (14/15) and 40.0% . The main adverse reactions were bronchospasm and hemoptysis, followed by cough, shortness of breath, fatigue, nausea and vomiting and myelosuppression. Conclusion CT-guided ILBT in the treatment of recurrent bronchogenic carcinoma is a safe and effective palliative treatment for cancer. It is worth further investigation to expand the sample size.