Evaluation of bronchial arterial infusion therapy combined with radiotherapy for non-small cell lung carcinoma

摘要

原発性非小細胞肺癌に対するBAI併用の有用性を検討するため88年10月から95年5月に治療を開始したBAI併用治療群 (BAI群) 31例と全身化学療法併用治療群 (SC群) 33例を対象とし retrospective に治療成績を比較検討した。放射線治療は化学療法と sequential に併用, BAI群では platinum 製剤を単独で, SC群では platinum 製剤, MMC, VDSを用いている。生存率, 局所制御及び遠隔制御率, 一次効果, 副作用の重症度を比較し統計学的有意差を検討した。BAI群の2, 3, 5年生存率はそれぞれ43.2%, 22.4%, 9.0%でMSTは21.7ケ月, 奏功率は61.2%, 局所, 遠隔再発率はそれぞれ15.4%, 16.1%で, SC群では2, 3, 5年生存率は33.3%, 17.0%, 0.0%, MST19.5ケ月, 奏功率69.7%, 局所, 遠隔再発率は66.7%, 21.2%であった。有意差はみられなかったが生存期間, 局所及び遠隔制御期間はBAI群で延長する傾向を認めた。副作用では白血球減少の重症度が有意にBAI群で低下していた。BAI群31例単独の検討では単回施行例 (19例), 2回施行例 (12例) の奏功率はそれぞれ47.3%, 83.3%で有意差を認め, 一次効果の良好であった症例の生存期間が有意差を持って延長していた。今後はBAI施行時多剤の併用, 放射線治療の同時併用, 効果のある症例に対しては施行回数を増やすことで局所制御を改善させる必要があるものと考えられる。 / Purpose : To evaluate the utility of bronchial arterial infusion therapy (BAI) for the patient with non-small cell lung carcinoma (NSCLC), we retrospectively compared the therapeutic results of BAI group (31 cases) with systemic chemotherapy group (SC group, 34 cases). Methods and materials : All the 64 patients have been performaed BAI or SC with a sequential combination of radiotherapy since October 1988 to May 1995. Cisdiammine dichloroplatinum (CDDP) or 1, 1-cyclobutane dicarboxylateplatinum (CBDCA) was administrated for aniti-cancer agent in BAI group, mytomycinC and vindesine were added to CDDP or CBDCA in SC group. We observed the cause-specific survival rate, local and distant control rate, initial response, side effects and analyzed the statistical difference. Results : In BAI group 2, 3, and 5-year overall survival rate were 43.2%, 22.4%, and 9.0% respectively, and MST was 21.7 months. The effective rate and local, distant recurrent rate were 61.2% and 15.49%, 16.1% respectively. There were no significant differences, but survival time, local and distant control time of BAI group tended to prolong in comparison with SC group. The grade of leukocytepenia in BAI group was significantly decreased. The number of BAI therapy was once in 19 cases and twice in 12 cases. The effective rates of each case were 47.3% and 83.3%, the initial response of the patients twice performed BAI was significantly better than the patients only once received BAI. The initial efficacy is crucial to improve the survival rate of BAI group. Conclusion : Combined administration of several anti-cancer agents in addition to CDDP or CBDCA and concurrent radiotherapy improved the local contorol of NSCLC. Our results strongly suggest that the repeated therapy of BAI should be recommended for the patients whose BAI was effective.