CAJ | 학술논문

目的观察125I粒子植入联合吉西他滨和顺铂(简称GP)方案治疗不可手术切除Ⅲ期NSCLC的临床疗效.方法 2005年1月至2008年6月的不可手术切除Ⅲ期NSCLC患者39例,给予125I粒子植入联合GP方案(按体表面积吉西他滨1000 mg/m2,顺铂75 mg/m2)化疗(联合组).采用TPS制定125I粒子植入数量和布源方法,在CT引导下经皮穿刺组织间植入125I粒子,处方剂量为110～130 Gy,术后应用TPS进行剂量验证.植入术后1周开始化疗.另设同时期39例不可手术切除Ⅲ期NSCLC患者为对照组,行3D-CRT序贯GP方案化疗.所有患者均经病理学检查确诊,化疗后每3个月复查胸部CT,随访24个月.比较2组患者的近期(即治疗开始后3个月)有效率、生存率、生存时间差异,数据分析采用χ2检验、Kaplan-Meier法、Log-rank法.结果联合组近期有效率为71.8%(28/39),与对照组(61.5%,24/39)相比差异无统计学意义(χ2=0.93,P>0.05),但肿瘤CR率与对照组相比差异有统计学意义(χ2=4.48,P<0.05);联合组和对照组的1年生存率分别为79.5%(31/39)和66.7%(26/39),差异无统计学意义(χ2=1.57,P>0.05),2年生存率分别为41.0%(16/39)和23.1%(9/39),差异有统计学意义(χ2=4.07,P<0.05).联合组和对照组的中位生存时间分别为(18.9±2.7)个月和(14.2±0.7)个月,差异有统计学意义(χ2=4.63,P<0.05).联合组Ⅲ～Ⅳ级放射性肺炎、放射性食管炎及骨髓抑制总发生率和对照组差异有统计学意义(χ2=13.94,P<0.05 ).125I粒子植入术中发生轻度气胸2例,出现术后少量咳血痰2例,无粒子局部脱落者.结论 125I粒子植入联合GP方案化疗治疗不可手术切除Ⅲ期NSCLC有很好的肿瘤CR率及2年生存率;125I粒子植入是有效的、安全的微创介入治疗方法.
목적 관찰125I입자식입연합길서타빈화순박(간칭GP)방안치료불가수술절제Ⅲ기NSCLC적림상료효.방법 2005년1월지2008년6월적불가수술절제Ⅲ기NSCLC환자39례,급여125I입자식입연합GP방안(안체표면적길서타빈1000 mg/m2,순박75 mg/m2)화료(연합조).채용TPS제정125I입자식입수량화포원방법,재CT인도하경피천자조직간식입125I입자,처방제량위110～130 Gy,술후응용TPS진행제량험증.식입술후1주개시화료.령설동시기39례불가수술절제Ⅲ기NSCLC환자위대조조,행3D-CRT서관GP방안화료.소유환자균경병이학검사학진,화료후매3개월복사흉부CT,수방24개월.비교2조환자적근기(즉치료개시후3개월)유효솔、생존솔、생존시간차이,수거분석채용χ2검험、Kaplan-Meier법、Log-rank법.결과 연합조근기유효솔위71.8%(28/39),여대조조(61.5%,24/39)상비차이무통계학의의(χ2=0.93,P>0.05),단종류CR솔여대조조상비차이유통계학의의(χ2=4.48,P<0.05);연합조화대조조적1년생존솔분별위79.5%(31/39)화66.7%(26/39),차이무통계학의의(χ2=1.57,P>0.05),2년생존솔분별위41.0%(16/39)화23.1%(9/39),차이유통계학의의(χ2=4.07,P<0.05).연합조화대조조적중위생존시간분별위(18.9±2.7)개월화(14.2±0.7)개월,차이유통계학의의(χ2=4.63,P<0.05).연합조Ⅲ～Ⅳ급방사성폐염、방사성식관염급골수억제총발생솔화대조조차이유통계학의의(χ2=13.94,P<0.05 ).125I입자식입술중발생경도기흉2례,출현술후소량해혈담2례,무입자국부탈락자.결론 125I입자식입연합GP방안화료치료불가수술절제Ⅲ기NSCLC유흔호적종류CR솔급2년생존솔;125I입자식입시유효적、안전적미창개입치료방법.
Objective To assess the therapeutic effect of radioactive seed 125I brachytherapy combined with GP chemotherapy regimen (gemcitabine 1000 mg/m2, cisplatin 75 mg/m2) for inoperabale stage Ⅲ non-small cell lung cancer (NSCLC). Methods Thirty-nine documented inoperable stage Ⅲ NSCLC patients, enrolled between January 2005 and June 2008 for the study group, were treated with the combination of 125I brachytherapy and GP regimen. The brachytherapy methods were conducted according to TPS and each patient was treated under those patients were treated with standard GP regimen. Chest CT scans were performed every three months post-procedurally, until disease progression or recurrence. The follow-up time was up to twenty four months after treatment. In the control group, equal amount of Ⅲ stage NSCLC patients were treated with standard GP regimen alone. Chi-square test and survival analysis with Kaplan-Meier and Log-rank were used to compare the differences of recent (3 months after therapy)efficiency, survival rate, survival time between two groups. Results The re-cent effective rates of the study group (71.8%, 28/39) and control group (61.5%, 24/39) were not statistical different (χ2=0.93, P>0.05), yet the tumor CR rates in two groups showed significant disparity (χ2=4.48, P<0.05). The one-year survival rates of the study group and the control were 79.5% (31/39), 66.7%(26/39) respectively, with no significant difference (χ2=1.57, P>0.05). However, singificant differences (χ2=4.07, 4.63,both P<0.05) were found in 2-year survival rate and median survival time, with 41.0% (16/39) vs 23.1% (9/39) and 18.9±2.7 months vs 14.2±0.7 months. Conclusions 125I brachytherapy combined with GP regimen chemotherapy could be an effective treatment method and could improve the tumor CR rate and survival rate for patients with inoperable stage Ⅲ NSCLC.