经超声支气管镜~(125)I粒子植入联合全身化疗治疗晚期非小细胞肺癌大气道狭窄临床效果分析
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摘要
目的探究经超声支气管镜放射性粒子~(125)I植入术联合全身化疗治疗晚期非小细胞肺癌(NSCLC)大气道狭窄的临床效果。方法选择在本院进行治疗的86例晚期NSCLC合并气道狭窄患者作为研究对象,采用随机数字表法分为观察组、对照组,每组43例,观察组患者采用在右美托咪定复合舒芬太尼镇静下经超声支气管镜放射性粒子植入术联合吉西他滨、顺铂(GP)化疗;对照组仅采用GP化疗,对比两组治疗有效率、血清肿瘤标志物、不良反应发生情况以及1年生存情况。结果观察组肿瘤治疗有效率、气道狭窄治疗有效率显著高于对照组(P<0.05)。观察组治疗后气促指数低于对照组,气道管径、第1秒用力呼气量(FEV1)、6 min步行距离(6MWD)评分均显著高于对照组(P<0.05)。观察组治疗后CEA、SCCA、NSE显著低于对照组(P<0.05)。观察组咯血发生率显著高于对照组(P<0.05)。观察组存活率(83.7%)显著高于对照组(65.1%),中位生存时间为(7.53±1.66)个月,显著高于对照组为(5.17±1.02)个月(P均<0.05)。结论在右美托咪定复合舒芬太尼镇静下经超声支气管镜放射性粒子植入术联合全身化疗治疗晚期NSCLC气道狭窄患者有效率高,毒性反应患者可耐受,近期预后较好,是治疗晚期NSCLC气道狭窄的简单有效方法。
Objective To evaluate the clinical effect of ultrasound bronchoscopic ~(125)I seed implantation combined with systemic chemotherapy under sedation condition induced by dexmetomidine compound sufentanil in treating advanced non-small cell lung carcinoma(NSCLC) complicated by large airway stenosis. Methods A total of 86 patients with advanced NSCLC complicated by large airway stenosis,who received treatment at authors' hospital, were enrolled in this study. Using random digital table method,the patients were randomly and equally divided into observation group and control group with 43 patients in each group. For the patients of observation group ultrasound bronchoscopic ~(125)I seed implantation was carried out under sedation condition induced by dexmetomidine compound sufentanil, which was followed by additional systemic chemotherapy using gemcitabine and cisplatin(GP); while for the patients of control group only systemic chemotherapy using GP was adopted. The therapeutic effectiveness, serum tumor markers,adverse reactions and one-year survival were compared between the two groups. Results The effective rates of NSCLC and airway stenosis in the observation group were significantly higher than those in the control group(P<0.05). After treatment, the index of breath shortness in the observation group was lower than that in the control group. The airway diameter, forced expiratory volume in the first second(FEV1) and 6-minute walking distance(6 MWD) in the observation group were significantly higher than those in the control group(P<0.05). The postoperative CEA, SCCA and NSE values in the observation group were strikingly lower than those in the control group(P<0.05). The incidence of hemoptysis in the observation group was remarkably higher than that in the control group(P<0.05). The survival rate in the observation group was 83.7%, which was obviously higher than 65.1% in the control group, and the median survival time in the observation group was(7.53±1.66) months, which was evidently higher than(5.17±1.02) months in the control group(P<0.05).Conclusion Ultrasound bronchoscopic radioactive ~(125)I seed implantation under sedation condition induced by dexmetomidine compound sufentanil combined with additional systemic chemotherapy is an effective therapy for advanced NSCLC complicated by large airway stenosis, its toxicity can be well tolerated by patients and a good short-term prognosis can be expected. Therefore, this therapy is a simple and effective method for advanced NSCLC complicated by large airway stenosis.(J Intervent Radiol, 2019, 28: 542-546)
Objective To evaluate the clinical effect of ultrasound bronchoscopic ~(125)I seed implantation combined with systemic chemotherapy under sedation condition induced by dexmetomidine compound sufentanil in treating advanced non-small cell lung carcinoma(NSCLC) complicated by large airway stenosis. Methods A total of 86 patients with advanced NSCLC complicated by large airway stenosis,who received treatment at authors' hospital, were enrolled in this study. Using random digital table method,the patients were randomly and equally divided into observation group and control group with 43 patients in each group. For the patients of observation group ultrasound bronchoscopic ~(125)I seed implantation was carried out under sedation condition induced by dexmetomidine compound sufentanil, which was followed by additional systemic chemotherapy using gemcitabine and cisplatin(GP); while for the patients of control group only systemic chemotherapy using GP was adopted. The therapeutic effectiveness, serum tumor markers,adverse reactions and one-year survival were compared between the two groups. Results The effective rates of NSCLC and airway stenosis in the observation group were significantly higher than those in the control group(P<0.05). After treatment, the index of breath shortness in the observation group was lower than that in the control group. The airway diameter, forced expiratory volume in the first second(FEV1) and 6-minute walking distance(6 MWD) in the observation group were significantly higher than those in the control group(P<0.05). The postoperative CEA, SCCA and NSE values in the observation group were strikingly lower than those in the control group(P<0.05). The incidence of hemoptysis in the observation group was remarkably higher than that in the control group(P<0.05). The survival rate in the observation group was 83.7%, which was obviously higher than 65.1% in the control group, and the median survival time in the observation group was(7.53±1.66) months, which was evidently higher than(5.17±1.02) months in the control group(P<0.05).Conclusion Ultrasound bronchoscopic radioactive ~(125)I seed implantation under sedation condition induced by dexmetomidine compound sufentanil combined with additional systemic chemotherapy is an effective therapy for advanced NSCLC complicated by large airway stenosis, its toxicity can be well tolerated by patients and a good short-term prognosis can be expected. Therefore, this therapy is a simple and effective method for advanced NSCLC complicated by large airway stenosis.(J Intervent Radiol, 2019, 28: 542-546)
引文
[1]丁婷,周斐,陈晓霞.免疫治疗联合化疗治疗晚期肺癌的进展[J].肿瘤,2017,37:530-533.
[2]覃慧婵,黄斯明,柳广南,等.难治性恶性气管-支气管狭窄的治疗体会[J].中国内镜杂志,2013,19:81-83.
[3]仇学明,罗红来,历琴,等.气管内支架治疗气管及主支气管恶性狭窄疗效分析[J].中华结核和呼吸杂志,2013,36:547-548.
[4]龚正,张彩云,王艳华,等.气道内金属支架置入术联合放射性粒子植入对比放疗治疗肺癌气道狭窄的临床研究[J].介入放射学杂志,2016,25:870-873.
[5]Kusaba H,Saijo N.A summary report of response evaluation criteria in solid tumors(RECIST criteria[J].Gan To Kagaku Ryoho,2000,27:1-5.
[6]Ernst A,Feller-Kopman D,Becker HD,et al.Central airway obstruction[J].Am J Respir Crit Care Med,2004,169:1278-1297.
[7]李玺,陈明真,卢燕珊,等.超声支气管镜下局部注入顺铂治疗晚期中央型肺癌并气道外压性狭窄的研究(附10例报告)[J].中国内镜杂志,2017,23:88-91.
[8]刘志贞,陈恩国,闻胜兰,等.体外膜肺氧合支持下经纤维支气管镜介入治疗重度恶性肿瘤性气道狭窄3例[J].中华急诊医学杂志,2016,25:515-517.
[9]王勇,朱海东,郭金和.支架植入治疗恶性气道狭窄的研究进展[J].介入放射学杂志,2015,24:172-176.
[10]陶海云,屈中玉,魏光敏,等.影响放射性125I粒子植入治疗非小细胞肺癌近期疗效的因素分析[J].中华肿瘤防治杂志,2016,23:146-147.
[11]Oki M,Saka H,Ando M,et al.Transbronchial vs transesophageal needle aspiration using an ultrasound bronchoscope for the diagnosis of mediastinal lesions:a randomized study[J].Chest,2015,147:1259-1266.
[12]Martinez-Monge R,Subtil JC,Lopez-Picazo JM.Transoesophageal endoscopic-ultrasonography-guided125I permanent brachytherapy for unresectable mediastinal lymphadenopathy[J].Lancet Oncol,2006,7:781-783.
[13]裘海燕,许飞,张伟.125I粒子植入联合化疗治疗晚期非小细胞肺癌的近期疗效[J].南昌大学学报·医学版,2013,53:78-80.
[14]余建云,李林均,陈萍,等.局部晚期非小细胞肺癌同步放化疗并序贯化疗与单纯序贯放化疗的对比研究[J].肿瘤防治研究,2015,42:606-609.
[15]高立伟,刘宏,党国际.组织间粒子植入联合化疗与外照射联合化疗治疗非小细胞肺癌的近期疗效对比研究[J].中国实用医刊,2013,40:60-63.
[16]杨树法,樊喜文,张国庆,等.放射性125I粒子植入联合化疗治疗不可手术的局部晚期非小细胞肺癌的疗效和安全性[J].中华肿瘤杂志,2010,32:626-629.
[17]Zhang S,Zheng Y,Yu P,et al.The combined treatment of CT-guided percutaneous125I seed implantation and chemotherapy for non-small-cell lung cancer[J].J Cancer Res Clin Oncol,2011,137:1813-1817.
[2]覃慧婵,黄斯明,柳广南,等.难治性恶性气管-支气管狭窄的治疗体会[J].中国内镜杂志,2013,19:81-83.
[3]仇学明,罗红来,历琴,等.气管内支架治疗气管及主支气管恶性狭窄疗效分析[J].中华结核和呼吸杂志,2013,36:547-548.
[4]龚正,张彩云,王艳华,等.气道内金属支架置入术联合放射性粒子植入对比放疗治疗肺癌气道狭窄的临床研究[J].介入放射学杂志,2016,25:870-873.
[5]Kusaba H,Saijo N.A summary report of response evaluation criteria in solid tumors(RECIST criteria[J].Gan To Kagaku Ryoho,2000,27:1-5.
[6]Ernst A,Feller-Kopman D,Becker HD,et al.Central airway obstruction[J].Am J Respir Crit Care Med,2004,169:1278-1297.
[7]李玺,陈明真,卢燕珊,等.超声支气管镜下局部注入顺铂治疗晚期中央型肺癌并气道外压性狭窄的研究(附10例报告)[J].中国内镜杂志,2017,23:88-91.
[8]刘志贞,陈恩国,闻胜兰,等.体外膜肺氧合支持下经纤维支气管镜介入治疗重度恶性肿瘤性气道狭窄3例[J].中华急诊医学杂志,2016,25:515-517.
[9]王勇,朱海东,郭金和.支架植入治疗恶性气道狭窄的研究进展[J].介入放射学杂志,2015,24:172-176.
[10]陶海云,屈中玉,魏光敏,等.影响放射性125I粒子植入治疗非小细胞肺癌近期疗效的因素分析[J].中华肿瘤防治杂志,2016,23:146-147.
[11]Oki M,Saka H,Ando M,et al.Transbronchial vs transesophageal needle aspiration using an ultrasound bronchoscope for the diagnosis of mediastinal lesions:a randomized study[J].Chest,2015,147:1259-1266.
[12]Martinez-Monge R,Subtil JC,Lopez-Picazo JM.Transoesophageal endoscopic-ultrasonography-guided125I permanent brachytherapy for unresectable mediastinal lymphadenopathy[J].Lancet Oncol,2006,7:781-783.
[13]裘海燕,许飞,张伟.125I粒子植入联合化疗治疗晚期非小细胞肺癌的近期疗效[J].南昌大学学报·医学版,2013,53:78-80.
[14]余建云,李林均,陈萍,等.局部晚期非小细胞肺癌同步放化疗并序贯化疗与单纯序贯放化疗的对比研究[J].肿瘤防治研究,2015,42:606-609.
[15]高立伟,刘宏,党国际.组织间粒子植入联合化疗与外照射联合化疗治疗非小细胞肺癌的近期疗效对比研究[J].中国实用医刊,2013,40:60-63.
[16]杨树法,樊喜文,张国庆,等.放射性125I粒子植入联合化疗治疗不可手术的局部晚期非小细胞肺癌的疗效和安全性[J].中华肿瘤杂志,2010,32:626-629.
[17]Zhang S,Zheng Y,Yu P,et al.The combined treatment of CT-guided percutaneous125I seed implantation and chemotherapy for non-small-cell lung cancer[J].J Cancer Res Clin Oncol,2011,137:1813-1817.