| Background and objective: Lung cancer is one of serious cancer which threat human's life and health. Clinical research data shows that non-small cell lung cancer (NSCLC) accounts for 80% to 85% of all lung cancer. Surgical resection is still the most effective treatment for NSCLC, especially for early stage NSCLC, however, about 75% patients have no surgery opportunities while accepting treatment. Radiation therapy is generally used to treat these patients who have inoperable conditions due to medical reasons. Research data shows that, the main influence factor of patient survival is local control. But, the conventional radiotherapy often have the following limitations universally: (1) In chest, the scope of tumor invasion can't be accurately determined, so that it is difficult to estimate the scope of radiotherapy,; (2) The tumor moves up and down with every breath; (3) In chest, there are many important tissues and organs which need to be protected, such as spinal cord, normal lung tissue and the heart, and so on. Because of these limitations, for decades conventional radiotherapy failed to improve NSCLC therapeutic effect significantly. In recent years , three-dimensional(3D-CRT) and intensity modulated RT(IMRT)and more accurate radiotherapy equipment have obviously improved radiotherapy status. The main purpose is to enhance tumor area conformal and to increase the target area and surrounding normal tissues dose gradient. On irregular tumor area, it is obviously increasing the dose and better protecting the adjacent important normal tissues and organs, but the single radiotherapy for malignancy lung is not ideal. In recent years, for NSCLC, especially for advanced NSCLC has been paid more attention to comprehensive and sequential treatment, namely, from a single treatment mode to a combination therapy mode. This article aims to investigate the combined treatment technological feasibility, security and short term efficacy in radiotherapy and implantation of 5-FU slow release particles for NSCLC, at meantime to study the pharmacokinetics and side-effect of 5-FU slow release particles. Methods: From October 2007 to Febuary 2009. There 36 cases were diagnosed as NSCLC after checked by pathology or cytology. In those cases, including 26 male patients, 12 female patients, median age is 61.8 years old (41 to 77 years old); 19 squamous cell carcinoma, 14 adenocarcinoma, and 5 squamous cell adenocarcinomas. All selected patients'expected survival time is more than six months. All patients can not or do not accept surgery. According to the clinical TNM stage, 6 patients are in stage I to II, 17 patients are in stage IIIa. 15 patients are in stage IIIb; 36 patients were randomly divided into two groups, 18 patients were treated by using 5-FU slow release particles combined with 3D-CRT, we called unite group, we first implanted 5-FU slow release particle 500-1000mg for each patient; 3D-CRT was given after implating 5 days by 1.8-2.0Gy per fraction , 5 times per week, with total dose was 59.4 to 60Gy. And other 20 patients were treated with 3D-CRT only, we called contrast group, the radiotherapy pattern like units group.Results: All patients were successfully completed treatment. Two patients appeared pneumothorax , lungs compression less than 30%, and was absorbed by oneself after three days. The follow-up visit was proceeding, once a month at the first 3 months after the end of whole treatment. And after 3 months the follow-up visit is every 3-6 months. As a result, in units group, there were 5 cases showing CR, 10 cases showing PR, 3 cases showing NC and no patient showing PD. The overall rate (CR+PR) was 83.3%. In contrast group ,there were 3 cases showing CR , 8 cases showing PR, 7 cases showing NC and 2 cases showing PD. The overall rate (CR+PR) was 55.0%. The overall survival rate of units group at 1 and 2 years was 88.9% and 61.1%. The overall survival rate of contrast group at 1 and 2 years was 60.0% and 30.0%. The results show that it has statistically significant (P < 0.05).Conclusion: 5-FU slow release particles can prolong the regional action time and improve the regional concentration of chemotherapeutic drugs. Also since the drug concentration in patients'venous blood is extremely low, common adverse reaction and clinical side-effects won't appear while intravenous injection is done. The result shows that the effect of units group are better than contrast group. Using radiotherapeutic with interstitial implantation of 5-FU slow release particles not only has significant radiosensitivity effect, but also it is safe, minimally invasive, eutherapeutic and low complication rate, which is one of the effective measures to treat NSCLC synthetically. |
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