The Feasibility Study On Application And Therapeutic Evaluation Of Patients With Brain Metastases From Lung Cancer Treated By Micro-catheter Superselective Interventional Chemotherapy

Background and purpose: As one of the most common malignant tumor,lung cancer incidence increased year by year,the incidence of lung cancer with brain metastasis also gradually increased up to 20%-65%.Brain metastases became the most common intracranial tumor.The efficiency rate of whole-brain radiotherapy or whole-body chemotherapy was low,and the systemic response and cognitive injury were relatively large.Clinical curative effect of bronchial artery in interventional chemotherapy of lung cancer has been widely recognized,also has been widely used clinically.This study attempts to adopt micro-catheter super-selection of interventional treatment technology,trying to improve the curative effect and reduce the incidence of intracranial complications and adverse drug reactions.Once surgical treatment of primary tumors and metastases at the same time,to alleviate surgical pain and save medical costs,improve the prognosis and quality of life of patients.Methods:This study from September 2011 to August 2017,47 cases of lung cancer with single brain metastases,17 cases of lung cancer patients with cerebellar single brain metastases,3 cases of lung cancer with multiple metastasis had been researched in one operation by the micro-catheter super-selective interventional perfusion treatment of lung cancer primary tumors and intracranial metastases.We performed a Seldinger's femoral artery puncture catheterization and a microcatheter hyperselective perfusion under DSA for primary lung cancer and intracranial metastatic tumor.Hyperselective bronchial artery was selected for lung cancer,and intracranial metastatic tumor was used to conduct microcatheter hyperselective perfusion chemotherapy in the blood vessels of the distribution area of cerebral blood supply.The microcatheter went directly to the parts of the anterior cerebral artery a1-a3 and middle cerebral artery m1-m3,and the trophic artery of the tumor was determined by tumor staining and preoperative imaging examination.This procedure was performed every 4 w for 2 times in succession.Follow-up head enhanced MRI was used in 4 weeks after the last treatment to evaluate the short-term efficacy according to the RECIST.The prognosis was followed up,the changes of patients' KPS score were recorded,and patients' PFS,OS and MST were recorded,and survival analysis was conducted in combination with the above indicators.Results:It is feasible to use micro-catheter ultra-selective interventional therapy for primary lung cancer and brain metastatic tumor at the same time.No complications related to the micro-catheter were found in all cases,the adverse reactions of chemotherapy drugs and the intraoperative cerebral vasospasm were slightly controllable,and it was feasible to use microcatheter ultra-selective interventional therapy to treat lung cancer and brain metastatic tumor in one interventional operation.All patients in this study completed 2 times of operation.Among the 47 patients with brain metastasis,there were 17 cases of CR(36.17%),16 cases of PR(34.04%),9 cases of SD(19.15%)and 5 cases of PD(10.64%).ORR 70.21%(33/47),DCR89.39%(42/47).The longest survival was 26 months,the shortest was 3 months,the median survival was 10 months,and the average survival was 9.83 months.Self-care survival was longest at 13 months,shortest at 3 months,median at 6 months,average at 6.38 months.Disease-free progression survival was up to 8 months,with a minimum of 2 months,and a median of 4 months,with an average of 3.96 months.17 patients with cerebellar metastatic tumor were 4 cases of CR(23.53%),5 cases of PR(29.41%),7 cases of SD(41.18%)and 1 case of PD(5.88%).Intracranial lesions were ORR 52.94%(9/17),DCR 94.12%(16/17).The clinical features,short-term efficacy and survival of the patients were studied.Conclusion:Perfusion chemotherapy for lung cancer and brain metastatic tumor is feasible using microcatheter technique.The hyperselective perfusion of M1-M3,A1-A3 and posterior inferior cerebellar arteries by microcatheterization has not been reported.The perfusion of chemotherapy drugs through microcatheter is safe and reliable,and the overall drug dose can be tolerated by patients,which has achieved good short-term efficacy and slight controllable adverse reactions.The prognosis and survival analysis also indicated that the treatment of lung cancer and intracranial metastases improved the PFS,SCS and OS time of the patients.It is a good adjuvant and compatible therapy for surgery,radiotherapy,chemotherapy and targeted therapy.