Comparative Study Of DEB And PVA In Advanced Non-small Cell Lung Cancer

Background and objective:In recent years,the incidence and mortality of cancer have risen rapidly,and lung cancer has become the malignant tumor with the highest morbidity and mortality.At the time of diagnosis,less than 20% of patients are suitable for surgical resection,and most of them belong to the advanced stage of loss of resection.The side effects of traditional radiotherapy and chemotherapy are large,and the curative effect is not satisfactory.In order to effectively control the tumor,prolong the survival period,and improve the quality of life,interventional therapy came into being.With the continuous improvement of interventional instruments and materials,and the maturity of operational techniques,interventional therapies have undergone major changes,including the presence of drug-eluting beads(DEB).It is of great significance in history of transcatheter arterial chemoembolization(TACE),which has dual role of carrying and releasing drugs and embolizing tumor blood vessels.It increases the effective concentration of chemotherapeutic drugs in the tumor area while reducing systemic side effects.A large amount of studies on DEB currently focus on the treatment of hepatocellular carcinoma(HCC)and liver metastases,and has achieved good results.However,there are few reports in the application of lung cancer.This study aims to analyze the efficacy,safety and feasibility of DEB by comparing DEB and polyvinyl alcohol(PVA)chemoembolization in the treatment of advanced non-small cell lung cancer,and to explore the factors that may affect the efficacy of DEB.The drug-eluting beads used were CalliSpheres(made in China)microspheres in this study.Materials and methods:Patients with advanced non-small cell lung cancer who underwent bronchial artery chemoembolization(BACE)were enrolled in the Department of Interventional Radiography,the First Affiliated Hospital of Zhengzhou University from September 2016 to March 2019.According to the treatment plan,61 patients were divided into two groups: 28 patients in the DEB group and 33 patients in the PVA group.Both groups were treated with 40 mg THP and 0.4 mg gemcitabine,The DEB group used 300-500 um microspheres to load 100 mg of oxaliplatin to embolize the tumor to nourish the artery.The PVA group was perfused with 100 mg oxaliplatin and embolism was performed using a 350-560 um PVA.All patients were followed up for 3-25 months by clinic or telephone until death or March 2019.After interventional therapy,the modified response evaluation criteria in solid tumors(mRECIST)was used to evaluate the therapeutic effect.Survival analysis was performed by Kaplan-Meier method.Two independent sample t-tests were used to analyze the laboratory parameters of blood routine,liver function and kidney function before and 1 week after treatment.Summarize and record the occurrence of complications.Result:Interventional operation was successfully completed,and the technical success rate was 100%.The number of treatments in the DEB group(1.25 times/case)was less than that in the PVA group(1.818 cases/case),and there was a statistically significant difference between the two groups(P=0.009).There was no significant difference in blood routine,liver function and renal function(P>0.05);the related indicators were mostly within the normal range,and no significant abnormalities occurred.The objective response rate(ORR)of the two groups was 82.14% and 54.54% at 3 months after interventional therapy,and there was a statistical difference(P=0.022)between the two groups.The DEB group significantly prolonged the overall survival(OS)(P=0.034)and progression-free survival(PFS)(P=0.036);most patients had only adverse events after transient embolism,symptomatic treatment,and the symptoms gradually relieved or disappeared.All patients had no severe bone marrow,liver and kidney dysfunction and spinal cord arterial injury.In the DEB group,the efficacy of central lung cancer(7/10,70%)was lower than the peripheral type(16/18,88.89%),but there was no statistical difference between the two(P=0.315);the efficacy of adenocarcinoma(16/16,100%)was better than squamous cell carcinoma(8/12,66.67%)(P=0.028);the efficacy of stage III lung cancer(14/17,82.35%)is similar to that of stage IV(9/11,81.82%)(P=1.000);efficacy in newly diagnosed patients(9/9,100%)was higher than patients who underwent interventional therapy after other treatment failures(14/19,73.68%),but there was no statistical difference between the two groups.(P=0.144).Conclusion:1.DEB has high feasibility and safety in the treatment of advanced NSCLC,and its curative effect is better than PVA.2.The efficacy of DEB is related to the tumor pathological type of advanced NSCLC.