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.%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.
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