| OBJECTIVEThe aims of this study are to observe the effect and acute side-effects of 192-Iridium high dose rate intrabronchial brachytherapy (HDR-IBB) combined with bronchial artery infusion chemotherapy (BAI) and radiotherapy (RT) on non-small cell lung cancer, and also to assess the clinical value of the treatment of HDR-IBB combined with BAI and RT, and to explore a new method of combined treatment for inoperable non-small cell lung cancer (NSCLC)MATERIALS AND METHODSBetween May 1998 and October 2000 56 non-small cell lung cancer patients were treated. Of the 56 patients, there were 51 men and 5 women. The median age was 62.3 years with a range from 38 to 75years. Twenty four cases were the central type carcinoma of lung; and 32 were peripheral type. Thirty patients had squamous cell carcinoma; 23 patients had adenocacinoma; 2 patients had adenosquamous carcinoma and one had large cell carcinoma. According to the TNM classification criteria of UICC (1988), 4 cases were stage II, 22 stage IIIa, and 30 stage IIIb. The Karnofsky Perfomance Status (KPS) before treatment was more than 80 in 46 patients, 70 in 8 patients, 60 in 2 patients.56 patients were randomized into two different therapeutic groups. Group I (BAI+RT group) was comprised of 31 patients treated with bronchial artery infusion chemotherapy(BAI) in combination with radiotherapy; Group II (BAI+RT+IBB ) consisted of 25 patients who were treated with 192-Iridium high dose rate intrabronchial brachytherapy with bronchial artery infusion chemotherapy and radiotherapy. Both groups were comparable regarding age, sex, tumor stage, macropathologic and histologicfindings, and KPS.31 patients in Group I received a total of 60 BAI treatments, four patients received only one times, 25 of those received twice, and 2 patients received three treatments. One of the chemotherapeutic regimes was MFP with MMC 6-8mg/m2, 5-Fu or FUDR 300-500mg/m2, DDP 50-80mg/m2. Another regime was FAP (or FTP) with 5-Fu or FUDR 300-500 mg/m2; ADM 20mg/m2 or THP 20-30mg /m2; DDP 50-80mg/m2. The intervals between two cycles were 2-3 weeks. Following this therapy 31 patients received radiotherapy in 1-2 weeks. The median dose was 5800cGy/29f/5.8w, with a range from 5000cGy /25f/5w to 6400cGGy/32f /6.4w.In Group II (BAI+RT+IBB group) 25 patients underwent a treatment of high dose rate intrabronchial brachytherapy (HDR-IBB) on the basis of the treatment of bronchial artery infusion and radiotherapy (RT). BAI treatment had the same chemotherapetic regimes as Group I . The median dose of radiotherapy was 5400cGy /27f/5.4w, ranged from 4000cGy/20f/4w to 5800cGy/29f/5.8w. HDR-IBB was delivered by using a remote afterloading (WD-HDR18) with a single 192-Iridium 10 Gi high activity source attaching to a stainless steel cable. The applicator was implanted to the tumor by a 9F catheter under fluoroscopy. Treatment planning system(TPS) was designed by Paris- II system. The length of treatment varied from 1to 8 cm. Reference point was chosen at a distance of 10mm or 15mm from the central axis. A median dose of lOOOcGy per fraction at both reference points (range from 600to 1500cGy) was prescribed. The total dose had a range from 600 to 3000cGy with a median dose of 2000cGy at both reference points. One to three fractions were administered, and the interval of two fractions was about 1 week. According to the sequence of combined treatment, the protocol was designed two kinds; (1) one to three cycles of BAI treatment were performed at first, then 1-3 fractions of IBB was prescribed, at last the treatment of RT was underwent; (2) 1 -3 cycles of BAI treatment were performed at first, then the treatment of RT was underwent, at last 1-3 fractions of HDR-IBB was prescribed. 25 patient in group II underwent a total of 48 BAI and 48 HDR-IBB treatments. Three patients received one BAI treatment, 21 patients received twice BAI treatment, 1 patient received 3 BAI treatments. Three patients received one HDR-IBB treatment, 21 patients received twice HDR-IBB treatment, and one patient re...
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