Combination Of Bronchial Arterial Infusion Chemotherapy Plus Drug-eluting Bead Transarterial Chemoembolization For Treatment Of Advanced Lung Cancer

Background and purpose:Lung cancer is one of the most popular malignant tumors,accounting for about 1/5 of all cancer deaths.Surgical resection is the first choice for early-stage lung cancer patients.However,most of the patients are in the advanced stage at the time of diagnosis and have lost the opportunity of tumor resection.At present,the main treatment for advanced lung cancer is radiotherapy and chemotherapy.However,due to the adverse reactions of radiotherapy and chemotherapy and the tolerance of tumor to chemotherapy drugs,the effect of radiotherapy and chemotherapy is unsatisfactory,and the overall 5-year survival rate is less than 18%.With the continuous progress of interventional radiology in materials and technology,interventional therapy plays an increasingly important role in the treatment of advanced lung cancer.BAI(bronchial arterial infusion)and TACE(transcatheter arterial chemoembolization)are mature interventional treatment technology.Its advantages lie in the high concentration of local drugs and the blocking of tumor blood supply arteries.DEB-TACE(drug-eluting beads-TACE).The emergence of DEB-TACE further improves the effectiveness of interventional tumor treatment.Loading chemotherapy drugs in microspheres may play a dual role as a slow and stable release of chemotherapy drugs and blocking the tumor blood supply.However,at present,only Kennoki reported two cases of lung cancer treated by bronchial arterial infusion chemotherapy plus drug-eluting bead transarterial chemoembolization,which achieved a remarkable short-term effect.There is a lack of clinical data to confirm the short-term and long-term efficacy of bronchial artery infusion chemotherapy combined with drug-loaded microsphere chemoembolization in the treatment of lung cancer.The purpose of this study is to evaluate the safety and efficacy of bronchial artery infusion chemotherapy combined with drug-loaded microsphere chemoembolization in the treatment of lung cancer and to provide a new treatment scheme for the treatment of advanced lung cancer.Materials and methods:This study included 33 patients with advanced lung cancer admitted to our center from January 2017 to March 2020.Each patient was treated with BAI combined with DEB-TACE.The choice of chemotherapy drugs and dosage depends on the pathological type,body surface area,age,constitution,etc.BAI schedule:Non-small cell lung cancer:Cisplatin 50-70mg and letterboxed 4mg;Small cell lung cancer:Cisplatin 50-70mg and etoposide 100mg.Drug-eluting beads(callisphere,Jiangsu Hengrui company)(300-500um)were used to load chemotherapy drugs:pirarubicin(THP)60mg for non-small cell lung cancer and irinotecan 80mg for small cell lung cancer.The feeding artery of the tumor was found under fluoroscopy,and the dose of chemotherapy drugs was allocated reasonably according to the number and staining degree of the feeding artery of tumor.After the infusion of chemotherapy drugs,the drug-loaded microspheres were slowly pushed through catheters or microcatheters until the tumor staining disappeared.Adverse reactions during and after operation were recorded.Chest enhancement CT was performed 30 days after the operation.The therapeutic effect was evaluated according to RECIST 1.1.All patients were followed up by in-hospital reexamination or telephone to record the patient’s survival status,survival period,date of death and the cause.The follow-up was up to the date of death or the last follow-up date(March 15,2020).Kaplan-Meier method was used for survival analysis and Cox proportional risk regression model was used for multivariate analysis.P<0.05,with statistical significance.Results:All the 33 patients were successfully found the feeding artery of the tumor and performed 1-2 cycles of BAI combined with DEB-TACE.Postoperative clinical evaluation included CR in 2 cases,PR in 22 cases,SD in 6 cases,PD in 3 cases.The total disease control rate(DCR)and the total objective response rate(ORR)were 90.9%and 72.7%respectively.It should be noted that 11 patients with different degrees of hemoptysis before operation did not have hemoptysis after the operation,and 14 patients with dyspnea before operation improved in different degrees.All the patients had no adverse reactions to grade Ⅲ-Ⅳ.The median OS was 11.2 months(95%CI 8.1-14.3 months).Multivariate analysis showed that tumor staining was an independent risk factor for survival(P=0.001,RR(95%CI),0.398(0.226-0.702)).Conclusion:It is safe and effective to treat advanced lung cancer with arterial infusion chemotherapy combined with drug-loaded microsphere chemoembolization,especially for patients with hemoptysis and dyspnea.Therefore,this is a novel treatment for advanced lung cancer.This is a novel and worthy of clinical application in the treatment of advanced lung cancer.