Luo Lingfei, Wang Hongwu, Ma Hongming, Zou Hang, Li Dongmei, Zhou Yunzhi
Minimal Invasive Tumor Therapy Center, Meitan General Hospital, Beijing 100028, China.
Zhongguo Fei Ai Za Zhi. 2010 May;13(5):540-3. doi: 10.3779/j.issn.1009-3419.2010.05.29.
Transcatheter arterial chemotherapy and embolization is the main method in the treatment of lung cancer, but most of the reports do not study individually to small cell lung cancer (SCLC), non-small cell lung cancer (NSCLC), hypovascular and hypervascular lung cancer. The pre-embolization perfusion of hemotherapeutics is still being used routinely and seldom report to iodized oil embolization. The article summarized the quality of life after the treatment, clinical efficiency, survival time and complications to evaluate the clinical effect of primary hypervascular NSCLC treated with embolization of emulsion of chemotherapeutics and iodized oil.
The study totally analyzed 41 cases which confirmed by pathology and follow up study from January, 2008 to January 2009. The CT scan with IV contrast demonstrates over moderate enhanced lesion which indicate hypervascular. Within the 41 cases, 23 cases of central, 18 cases of peripheral. Suqamous carcinoma 21 cases, adenocarcinoma 15 cases and squamoadenocarcinoma 5 cases. Stage IIIb 34 cases, stage IV 7 cases. Superselective incubation with microcatheter under DSA, to embolize the capillary bed with liquefied iodized oil and the emulsion of pharmorubicin, to embolize the supply artery of the tumor with gelatin foam microparticle. The liquefied iodized oil 5 mL-10 mL, pharmorubicin 10 mg-30 mg. The longest follow up is 12 months and to compare with the references of 2007-2009.
The KPS is widely acclaimed after the treatment (P < 0.05), no complete response (CR), 31 cases of partial response (PR), 7 cases of no change (NC) and 3 cases of progressive disease (PD), the total efficiency (CR+PR) is 75.6%. The clinical efficiency (CR+PR+NC) is 92.68%. 33 cases of total survival tome over 12 months (80.48%), IIIb stage 29/34 (85.29%), IV stage 4/7 (57.14%). 1 case with severe complication-spinal injury.
To treat primary hypervascular NSCLC with simple embolization of emulsion of chemotherapeutics and iodized oil is very useful and can avoid the side effect of chemotherapeutics. The key point to avoid spinal injury and other severe complications is to distinguish the spinal aretery and intratumor AV fistula by using superselective incubation with microcatheter under DSA.
经导管动脉化疗栓塞术是肺癌治疗的主要方法，但大多数报道未对小细胞肺癌（SCLC）、非小细胞肺癌（NSCLC）、乏血供和富血供肺癌进行单独研究。化疗药物的栓塞前灌注仍在常规使用，而关于碘化油栓塞的报道较少。本文总结了治疗后的生活质量、临床疗效、生存时间及并发症，以评估化疗药物乳剂与碘化油栓塞治疗原发性富血供NSCLC的临床效果。
本研究共分析了2008年1月至2009年1月间经病理确诊并随访的41例患者。静脉注射对比剂的CT扫描显示病变呈中度以上强化，提示为富血供。41例患者中，中央型23例，周围型18例。鳞癌21例，腺癌15例，腺鳞癌5例。Ⅲb期34例，Ⅳ期7例。在DSA引导下用微导管进行超选择性插管，用液化碘化油和表柔比星乳剂栓塞毛细血管床，用明胶海绵微粒栓塞肿瘤供血动脉。液化碘化油5 mL - 10 mL，表柔比星10 mg - 30 mg。最长随访时间为12个月，并与2007 - 2009年的参考文献进行比较。
治疗后KPS评分显著提高（P < 0.05），无完全缓解（CR），部分缓解（PR）31例，稳定（NC）7例，疾病进展（PD）3例，总有效率（CR + PR）为75.6%。临床有效率（CR + PR + NC）为92.68%。33例总生存时间超过12个月（80.48%），Ⅲb期29/34（85.29%），Ⅳ期4/7（57.14%）。1例出现严重并发症——脊髓损伤。
单纯用化疗药物乳剂与碘化油栓塞治疗原发性富血供NSCLC非常有效，且可避免化疗药物的副作用。避免脊髓损伤及其他严重并发症的关键在于在DSA引导下用微导管进行超选择性插管，以区分脊髓动脉和肿瘤内动静脉瘘。
