| BackgroundThe incidence rate of non-small cell lung cancer(NSCLC)accounts for about 13%among all the cancers now,while the 5-year survival rate of patients with terminal-stage NSCLC is still less than 5%.The incidence rate of NSCLC kept to go up gradually in the past 40 years,the data published by the national tumor register center in 2014 revealed that,the incidence of lung cancer in China in 2010 was 35.23/10 ten thousand,mortality rate was 27.93/10 ten thousand.About 80%-85%of lung cancers are NSCLC,more than half the patients who are recently diagnosed to have NSCLC are in the terminal stage with a poor prognosis.In recent years,with the increasingly updated and extensive development of tumor minimally-invasive ablation techniques,of which the excellent effect is obvious to all.The technology of argon-helium cryoablation ablation has been increasingly developed and perfected,it can rapidly reduce the tumor load and has a high rate of control of local tumor,which provides a new therapeutic method for the patients who are intolerant to surgery or who are in the middle or terminal stage of tumor.With the advancement of study on tumor cell molecular biology and genetics,a lowly toxic and highly effective drug that inhibits the signal transduction pathway was born at the right moment and provided more choices for the terminal-stage NSCLC patients.Erlotinib is a specific tyrosine kinase inhibitor,it can block the activation of phosphorylase by binding to the locus of phosphorylase of the tumor cells,and then inhibit the proliferation of tumor cell,induce the apoptosis of tumor cell while cause a little damage to the normal cell of organism,and it can significantly improve the living quality and survival time of patients with terminal-stage NSCLC(especially the adenocarcinoma of lung).AbjectiveThis study is intended to explore the clinical effect of argon-helium cryoablation ablation combined with erlotinib on treating the senile patients with middle and terminal stage of adenocarcinoma of lung and their safety and living quality,in order to contribute to the adoption of a comprehensive measure and to provide a referential basis for the improvement of living quality and survival time of patients.Method80 cases of senile patient with III-IV-stage adenocarcinoma of lung who was hospitalized in Shandong Qianfoshan Hospital from Jan,2015 to Oct,2015 and who had a complete medical data and follow-up visit record as well as EGFR gene mutation in the18th,19th and 21th exon were retrospectively analyzed and randomly divided into 2 groups,the group A(40 cases)was administered with argon-helium cryoablation combined with a targeted therapy by erlotinib,the group B(40 cases)was administered with a targeted therapy by erlotinib alone.The study protocol was approved by the ethicscommitte-e of HuashanHospital.Results1.The recent curative effect:Three months after treatment,CT evaluation condition changes,the effective rate(CR+PR)of group A was 85%,the clinical control rate(CR+PR+SD)of group A was 90%,the effective rate(CR+PR)of group B was 60%,the clinical control rate(CR+PR+SD)of group B was 80%,the difference in effective rate between two groupsafter treatmentwasst atistically significant(tested by chi-square test,x~2=6.270~a,P=0.012,P<0.05).the different ce in clinical control rate between two groupsafter treatmentwasnot statistically significant(tested by chi-square test,χ~2=0.882,P=0.348,P>0.05).2.Quality of lifeQLQ-C30 scale functional domain:the patients scored relatively high in cognitive function and relatively low in social function after 3 days of treatment.In terms of physical function score,group B>group A(P=0.018),the difference was statistically significant.The patients scored high in physical function and cognitive function and low in social function after 3 months of treatment.Group A scored higher in physical function,it was worked out by a t-test that P=0.024,the difference was statistically significant.QLQ-C30 scale symptom domain:the patients scored relatively high in fatigue,diarrhea and financial difficulty and low in nausea and vomit after 3 days of treatment.The group A scored relatively high in pain scale,P=0.008,the difference was statistically significant.The patients scored relatively high in fatigue,financial difficulty and diarrhea and low in nausea,vomit and painafter 3 months of treatment,pain score:group B>group A,(P=0.010),financial difficulty:group A>group B,(P=0.024),group A had a milder symptom of pain while a heavier financial burden.QLQ-C30 overall living quality:Group A scored higher than group B after 3 months of treatment,it was revealed that,group A scored higher in quality of life than group B did,the difference was statistically significant(tested by a t-test,P=0.039).3.Adverse reaction40 patients in group A received an argon-helium cryosurgery target ablation therapy,0case of death during operation,no severe complication occurred in perioperative period.65%of the patients were found to have a little hemoptysis(26/40),20%of them were found to have shiver(8/40),37.5%of them found to have fever(15/40),25%of them found to have pneumothorax(10/40),32.5%of them found to have pleural effusion(13/40)and 5%of them found to have subcutaneous emphysema(2/40).A total of 80 cases of patient in group A and B received a target therapy of erlotinib,according to the WHO adverse reaction grading standard,8.75%(7/80)of the patients were found to myelosuppression(above grade-III),20%found to have vomiting(16/80),25%found to have diarrhea(20/80)and 36.7%found to have rash and pruritus(29/80).4.survival analysisAll of the 80 cases of patient received a follow-up visit,the follow-up rate was 100%,the date of follow-up was from Jan,2015 to Jan,2017,the follow-up visit lasted from 6months to 24 months.The median survival time of group A and B was 16.6 and 15.1months,one-year survival rate was 87.5%and 75.0%.Tested by a Log-Rank test,(χ2=6.667,P=0.010),the difference was statistically significant,the argon-helium cryosurgery target ablation therapy combined with erlotinib was more able to extend the survival time of patients.Conclusions1.Argon-helium cryoablation combined with a targeted therapy by erlotinib has a higher efficiency than single use of erlotinib does in treating the senile patients with stage-III-IV adenocarcinoma of lung who had a genetic mutation of EGFR18th、19th or 21th exon,but the difference in clinical control rate between the both is not significant.2.Compared with the single-drug group,the living quality of patients in the group treated by argon-helium cryoablation combined with a targeted therapy by erlotinib is influenced shortly and temporarily,their life quality can be significantly improved by an active therapy and recovery,however with a heavier financial burden.3.Compared with single use of erlotinib,argon-helium cryoablation combined with a targeted therapy by erlotinib can rapidly reduce the tumor load despite of a few occurrences of postoperative complication,but the patient survival time can be extended and their life quality can be significantly improved.The treatment by argon-helium cryoablation combined with a targeted therapy by erlotinib is a safe and effective therapeutic method for the senile patients with III-IV stage adenocarcinoma of lung who had 18th,19th or 21th exon EGFR gene mutation and lost the chance to be a candidate to radical operation. |
