Transcatheter arterial infusion chemotherapy followed by surgery in patients with unresectable stage III non-small cell lung cancer / 肿瘤

ABSTRACT

Objective: To evaluate the clinical response, adverse reactions and prognosis of transcatheter arterial infusion (TAI) chemotherapy followed by surgery in patients with unresectable stage III non-small cell lung cancer (NSCLC). Methods: A retrospective study was performed in 81 patients with unresectable stage III NSCLC. All patients received 2 cycles of TAI chemotherapy. Surgical treatment was performed for patients with partial response or patients with stable disease and tumor reduction. The primary endpoint was overall survival (OS) and the secondary endpoints were disease control rate (DCR) and adverse reactions. Results: The results of response evaluation after 2 cycles of TAI chemotherapy were partial response in 40 patients (49.4%), stable disease in 30 patients (37.0%) and disease progression in 11 patients (13.6%); the DCR was 86.4% (70/81). The main adverse reactions were graded as I-II. In 55 patients undergoing TAI chemotherapy, the surgical resection rate was 94.5% (52/55), and the postoperative complication rate was 32.7% (18/55); the 1-, 2- and 3-year survival rates were 78.2%, 52.7% and 34.5%, respectively. The subgroup analysis showed that the OS of the patients with partial response was significantly better than that of the patients with stable disease; the median survival time were 37.0 and 21.0 months, respectively (P = 0.01 9). The median survival time (34.0 months) of the patients diagnosed of squamous cell carcinoma was longer than that of the patients diagnosed of adenocarcinoma (13.5 months), but the difference was not statistically significant (P = 0.101). The results of multivariate analysis showed that the short-term response was an independent prognostic factor, and the prognosis of patients achieving partial response was better than that of the patients achieving stable disease (the hazard ratio was 0.467, the 95% confdence interval was 0.238 to 0.916; P = 0.027). Conclusion: For patients with unresectable stage III NSCLC, TAI chemotherapy is an effective and safe neoadjuvant therapy, especially for patients with partial response or preoperative diagnosis of squamous cell carcinoma, and the postoperative survival benefits are more significant.