Intratumoral administration of cisplatin through a bronchoscope followed by irradiation for treatment of inoperable non-small cell obstructive lung cancer
Intratumoral administration of cisplatin through a bronchoscope followed by irradiation for treatment of inoperable non-small cell obstructive lung cancer
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DOI：
10.1016/j.lungcan.2005.10.012
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发表时间：
2006-02-01
期刊：
影响因子：
5.3
通讯作者：
Goldberg, EP
中科院分区：
文献类型：
--
作者：
Celikoglu, F;Celikoglu, SI;Goldberg, EP
目的：不能手术的非小细胞肺癌合并严重支气管梗阻的患者发展为梗阻后肺炎或呼吸衰竭的风险很高。这通常会在几周到几个月内导致死亡。一些研究表明，最初使用Nd-YAG激光光切除术或冷冻疗法来减少阻塞气道的体积，通过减少感染和呼吸功能不全来减少发病率。这可以缩短住院时间，提高生活质量，延长生存期。也有研究表明，先进行减脂治疗，然后再进行放射治疗的患者比同样接受放射治疗的患者生存率更高。肿瘤内（IT）注射细胞毒性药物（IT化疗）也已成功地用于清除气道。本研究的目的是研究顺铂联合放射治疗阻塞性不能手术的非小细胞肺癌的有效性、安全性和可行性。患者和方法：23例患者首先在支气管镜下注射顺铂溶液（4mg /ml） 40mg，每周给药4次（第1、8、15、22天），然后照射治疗。结果：在3周的IT治疗结束时，23例患者中有11例气道管腔直径增加超过50%（良好缓解），8例患者改善25-50%（部分缓解），4例患者增加小于25%（小缓解）。总体而言，23例患者中有19例认为通过IT化疗减积是临床有效的，只有4例患者是轻微有效的。统计分析显示，所有患者的管腔直径均有统计学意义的改善（P < 0.001）。与部分缓解的患者（中位生存期342天）相比，IT化疗和放疗的联合治疗延长了良好缓解患者的生存期（中位生存期636天）。仅有少量反应的4例患者的中位生存期为202天。结论：肿瘤内注射顺铂是一种安全、简单、经济有效的治疗方法。没有严重的副作用和并发症。最初通过顺铂治疗阻塞气道，然后进行放疗，需要进一步研究以确定其对生存的影响。2005爱思唯尔爱尔兰有限公司版权所有。
Purpose: Patients presenting-with inoperable non-small cell carcinoma of the lung associated with severe bronchial'obstruction are at a high risk for developing post-obstructive pneumonia or respiratory failure. This often Leads to death in weeks to months. Several studies suggest that initial use of debulking of obstructed airways by Nd-YAG laser photo resection or by cryotherapy lessens morbidity by reducing infections and respiratory insufficiencies. This can shorten hospitalization, improve the quality of life, and prolong survival. It has also been demonstrated that patients first treated for debulking and then by irradiation have better survival than similar patients treated with irradiation atone. Intratumoral (IT) injection of cytotoxic drugs (IT chemotherapy) has also been successfully used to debulk airways. The aim of the present work was to study the effectiveness, safety, and feasibility of initial debulking by IT chemotherapy with cisplatin combined with irradiation with a curative intent in the treatment of obstructive inoperable non-small cell lung cancer.Patients and methods: Twenty three patients were treated first by bronchoscopic IT injection of up to 40 mg cisplatin solution (4 mg/ml), administered weekly four times (on days: 1, 8, 15, 22) and then by irradiation.Results: At the end of a 3-week period of IT treatment, 11 of 23 patients showed an increase in airway lumen diameter of more than 50% (good response), 8 patients showed an improvement of 25-50% (partial response) and 4 patients showed an increase of less than 25% (small response). Overall, debulking by IT chemotherapy was considered clinically effective in 19 of 23 patients and only marginally effective in 4 patients. Statistical analysis indicated a statistically significant improvement in lumen diameter (P < 0.001) for all patients. The combination of IT chemotherapy and irradiation resulted in prolonged survival in the patients with good response (median survival 636 days) compared to patients with partial response (median survival 342 days). The four patients with only a small response had a median survival of 202 days.Conclusions: Debulking by intratumoral injection of cisplatin was shown to be a safe, simple, and cost effective procedure. There were no severe side effects and complications. Initial debulking of obstructed airways by IT administration of cisplatin, followed by irradiation requires further studies in order to determine its effect on survival. (c) 2005 Elsevier Ireland Ltd. All rights reserved.