Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China.
Cryobiology. 2013 Oct;67(2):225-9. doi: 10.1016/j.cryobiol.2013.07.003. Epub 2013 Jul 31.
Most patients with central type lung cancer (CTLC) are not candidates for surgery; systemic chemotherapy and external beam radiotherapy are the main treatments but have not greatly affected patient outcome. Combined percutaneous and endobronchial cryotherapy has been used successfully to treat CTLC; this study aimed to determine its feasibility and safety. Forty-seven patients with unresectable CTLC (22 endotracheal, 26 tracheal wall and 21 extratracheal tumors) underwent 69 sessions of combined percutaneous cryosurgery, endobronchial cryosurgery and airway stenting. The long diameter of all tumors was <5 cm. Biopsy showed non-small cell lung cancer (NSCLC) in 40 patients (medium or well differentiated in 20 cases, poorly differentiated in 20) and small cell lung cancer (SCLC) in seven. Within 3 days after treatment, ventilatory capacity and performance status had obviously increased and cough, signs of dyspnea, hemoptysis and atelectasis improved significantly, but symptoms of pneumothorax and pleural effusion emerged. After 2 weeks, all complications had disappeared completely, as had cough. Progression-free survival (PFS) for endotracheal tumors (8 ± 4 months) was shorter than that for tracheal wall (13 ± 6 months, P < 0.05) and extratracheal (14 ± 8 months, P < 0.01) tumors. The PFS of NSCLC (11 ± 5 months) was significantly longer than that of SCLC (4 ± 2 months, P < 0.0001). The PFS of medium or well differentiated CTLC (15 ± 8 months) was significantly longer than that of poorly differentiated CTLC (7 ± 3 months, P < 0.0001). In conclusion, combined cryotherapy is a safe and effective treatment for CTLC, with PFS largely influenced by tumor location and pathologic type.
大多数中央型肺癌（CTLC）患者不适合手术；全身化疗和外照射放疗是主要治疗方法，但并未显著影响患者预后。经皮联合支气管内冷冻疗法已成功用于治疗 CTLC；本研究旨在确定其可行性和安全性。47 例不可切除的 CTLC 患者（22 例气管内、26 例气管壁和 21 例气管外肿瘤）接受了 69 次经皮冷冻治疗、支气管内冷冻治疗和气道支架置入术。所有肿瘤的长径均<5cm。活检显示 40 例患者为非小细胞肺癌（NSCLC）（中或高分化 20 例，低分化 20 例），7 例为小细胞肺癌（SCLC）。治疗后 3 天内，通气能力和功能状态明显改善，咳嗽、呼吸困难体征、咯血和肺不张明显改善，但出现气胸和胸腔积液症状。2 周后，所有并发症均完全消失，咳嗽也消失。气管内肿瘤（8±4 个月）的无进展生存期（PFS）短于气管壁（13±6 个月，P<0.05）和气管外肿瘤（14±8 个月，P<0.01）。NSCLC（11±5 个月）的 PFS 明显长于 SCLC（4±2 个月，P<0.0001）。中或高分化 CTLC（15±8 个月）的 PFS 明显长于低分化 CTLC（7±3 个月，P<0.0001）。总之，联合冷冻疗法是治疗 CTLC 的一种安全有效的方法，PFS 主要受肿瘤位置和病理类型的影响。
