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目的评价支气管动脉灌注今又生(重组人p53腺病毒注射液)联合EP方案同期放化疗治疗老年T4N0-2M0局部晚期非小细胞肺癌患者的近期疗效和不良反应。方法 2010年1月—2012年12月经病理确诊、免疫组化检测p53蛋白表达突变型的老年(65岁≤年龄≤75岁)T4N0-2M0局部晚期NSCLC患者26例,行支气管动脉灌注今又生2次,每次4×1012 VPs,注射时间分别为化疗周期开始前3d。联合同期放化疗治疗,化疗为EP方案,顺铂:50mg/m2,d1、8、29、36静脉滴注,足叶乙甙:50mg/m2,d1~5、d29~33静脉滴注。采取3D-CRT放疗,中位剂量为60Gy/30次,每周5次。结果随访率为100%。有效率76.9%(20/26),3级放射性食管炎4例(15.4%)、3级放射性肺炎3例(11.5%)。1年总生存率73.1%,1年无进展生存率57.7%。结论支气管动脉灌注今又生联合同期放化疗治疗老年T4N0-2M0局部晚期非小细胞肺癌取得较好近期疗效、不良反应可以耐受,值得推广。
Objective To evaluate the short-term effects and side effects of bronchial arterial infusion therapy and present (recombinant human p53 adenovirus injection) combined with EP regimen concurrent chemoradiotherapy in elderly patients with locally advanced non-small cell lung cancer T4N0-2M0. Methods From January 2010 to December 2012, 26 patients with T4N0-2M0 locally advanced NSCLC who had a mutation of p53 protein were detected by immunohistochemistry in the elderly (65 years old ≤ age ≤75 years old). Bronchial artery infusion 2 times, each time 4 × 1012 VPs, injection time were 3 days before the start of the chemotherapy cycle. Chemotherapy for the same period combined radiotherapy and chemotherapy for the EP program, cisplatin: 50mg / m2, d1,8,29,36 intravenous infusion, etoposide: 50mg / m2, d1 ~ 5, d29 ~ 33 intravenous drip. Take 3D-CRT radiotherapy, the median dose of 60Gy / 30 times, 5 times a week. Results The follow-up rate was 100%. The effective rate was 76.9% (20/26), grade 3 radiation esophagitis in 4 cases (15.4%) and grade 3 radiation pneumonia in 3 cases (11.5%). The 1-year overall survival rate was 73.1% and the 1-year progression-free survival rate was 57.7%. Conclusion Bronchial artery infusion combined with concurrent radiotherapy and chemotherapy in the treatment of elderly patients with locally advanced non-small cell lung cancer T4N0-2M0 recent good effect, adverse reactions can tolerate, it is worth promoting.