2.生活质量的改变：（1）原有胸痛者41例，治疗后完全止痛21例（51.2%），部分止痛者16例（39.0%），无效者4例（9.8%）。（2）体重：74例中体重增加者56例（75.7%），体重稳定者8例（10.8%），体重下降者10例（13.5%）。（3）卡比评分：有56例接受评价，其中增加者48例（85.7），降低者8例（14.3%）。
3．生存期：74例中至今健存者66例（81.1%），随访1年上的病例共有42例，有32例仍健存，1年生存率76.2%；死亡的8例中，3例死于肿瘤扩散引起呼吸衰竭，2例死于肺部感染，1例死于脑溢血，1例死于心肌梗塞，1例死因不明。
讨论
不能手术切除肺癌的治疗效果目前甚不理想，1年生存率不越过30%，全身化疗的应答率一般在20%左右，且副反应甚大，单纯放疗的有效率也不高，CR少于10%。本组病例接受了由多种疗法组成的序贯治疗，CR达28.4%，PR41.9%，两者加起来有效率达70.3%；生存质量改善，止痛有效率达90%（完全＋部分止痛），大部分病例体重增加，有85.7%的病例卡氏评分增加；1年生存率76.2%。这一结果远优于一般的文献报告。
本组病例之所以取得较好疗效，可能与多种方法的协同作用有关。血管介入治疗由于能够选择性地实施局部高浓度化疗，显然较一般全身化疗效果更好；在化疗中应用中药也可能为提高疗效的因素之一；氩氦刀或射频刀能有效地消除肿瘤组织，其效果几乎与手术切除相同；光动力学治疗能有效地清除气管内或支气管内瘤组织，迅速地改善病人症状；免疫治疗和中医中药能提高病人机体抗瘤能力。根据病人情况将上述疗法序贯应用，可达到相辅相成的效果。
结论
将血管介入治疗、氩氦刀冷冻、光动力、放疗、免疫以及中医中药等疗法组合起来，序贯应用，可显著提高不能手术切除肺癌的治疗效果。
Multimodalitic
Sequential Therapy for Unresectable
Non-Small -Cell Lung Cancer:Prospective
trial for 85 Cases
Niu
LZ,Zhou Q,Guo ZQ,Xu KC
Guangzhou Fuda Institute
of Lung Cancer;Guangzhou
Fuda Cancer Hospital,Guangzhou,510300,China
Abstract
Purpose:The
aim of the present study
was to evaluate the efficacy
of the sequential therapy
consisted of multimodality
in unresectable non-small-cell
lung cancer(NSCLC).
Patients
and Methods:Eight-five patients
with NSCLC were those who
had progressed or relapsed
after therapy with routine
chemotherapy or/and radiotherapy,and
were not given operation
due to tumor factor or refused
operation.The therapy was
consisted of transarterial
chemotherapy targeted to
tumor vessels in lung,cryoablation
with Endocare System (Endocare,Irvine,CA,USA),photodynamic
therapy with Photofrin or
Photosan as photosensetizer
for obstructive cancer in
intratrachea or intrabronchea,radiotherapy
for patients without previous
same therapy,immunotherapy
with cytokine-induced killer
cells or dendritic cells(DC),and
traditional Chinese medicine,that
were used in sequence.
Results:
Seventy-four
patients were entered onto
the perspective study with
follow-up duration of 6-21
months.Responses included
CR(complete response) in
21 cases(28.4%),PR(partial
response),31cases(41.9%),MR(minor
response),8 cases(10.8%),NC(no
change),9 cases(12.2%),and
PD (progressive disease),in
5 cases(6.7%).The pain in
patients of 51.2 percent
(21/41) had complete remmision
and in 39.0%(16/41) had
partial remmision.75.7percent(36/74)
of patients had increased
body weight,and 10.8 percent
had stable body weight.85.7
percent(48 cases) of 56
patients were recieved evaluation
of performance status had
increased Karnovsky score.Among
74 cases,66 cases(81.1%)
were alive up to now with
the 1-year survival rate
of 76.2 percent.
Conclusion:In
the present perspective
study,the multimodalitic
sequential therapy seems
highly effective in patients
with unresectable USCLC.
