Effect of intensity modulated radiation therapy combined with concurrent CF regimen on IGF-1 and VEGF and prognosis of esophageal squamous cell carcinoma
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摘要:
目的分析调强放疗联合同期亚叶酸钙（CF）方案对食管鳞癌胰岛素样生长因子1、血管内皮生长因子水平变化及预后的影响。 方法选取2015年1月~2018年1月我院肿瘤科收治的110例食管鳞癌患者，随机分为放疗组（采用调强放疗进行治疗）与放化疗组（采用调强放疗联合同期CF方案化疗进行治疗），55例/组，比较两组患者治疗后近期疗效、血清肿瘤标记物、毒副反应以及生存情况的变化情况。 结果放化疗组治疗后近期疗效和放疗组差异无统计学意义(P>0.05)；两组治疗后胰岛素样生长因子1、血管内皮生长因子、鳞状细胞癌抗原、癌胚抗原水平明显降低(P < 0.05)，放化疗组低于放疗组(P < 0.05)；两组毒副反应发生率差异无统计学意义(P>0.05)；放化疗组2年、3年生存率明显高于放疗组(P < 0.05)，两组中位无进展生存时间、总生存时间差异均有统计学意义(P < 0.05)。 结论调强放疗联合同期CF方案化疗治疗食管鳞癌患者近期疗效较好，可降低血清肿瘤标记物水平，不增加毒副反应发生，提高患者生存率，延长患者生存时间。 Abstract:ObjectiveTo analyze the effect of intensity modulated radiation therapy combined with concurrent calcium folinate (CF) regimen on changes of levels of insulin-like growth factor 1 and vascular endothelial growth factor and prognosis of esophageal squamous cell carcinoma. MethodsA total of 110 patients with esophageal squamous cell carcinoma admitted to department of oncology of the hospital were selected between January 2015 and January 2018. They were randomly divided into radiotherapy group (treated with intensity modulated radiation therapy) and chemoradiotherapy group (given intensity modulated radiation therapy combined with concurrent CF chemotherapy regimen), with 55 cases in each group. The short-term efficacy, serum tumor markers, toxic and side effects and survival status were compared between the two groups after treatment. ResultsThe difference in the short-term efficacy between chemoradiotherapy group and radiotherapy group after treatment was not significant (P>0.05). The levels of insulin-like growth factor 1, vascular endothelial growth factor, squamous cell carcinoma and carcinoembryonic antigen after treatment were significantly decreased in the two groups (P < 0.05). The levels of chemoradiotherapy group were lower than those of radiotherapy group (P < 0.05). The differences in the incidence rates of toxic and side effects between the two groups was not significant(P>0.05). The 2-year and 3-year survival rates were significantly higher in chemoradiotherapy group compared with those in radiotherapy group (P < 0.05). The differences in the median progression-free survival time and overall survival time between the two groups were significant (P < 0.05). ConclusionIntensity modulated radiation therapy combined with concurrent CF chemotherapy regimen has a good short-term efficacy in the treatment of esophageal squamous cell carcinoma. It can reduce the levels of serum tumor markers, do not increase the occurrence of toxic and side effects, improve the survival rate and prolong the survival time of patients. -
图 1 病理检查结果
A: 食管镜病理学检查提示高中分化鳞状细胞癌(治疗前)；B: 食管镜病理学检查提示食管中度异型增生(治疗后).
Figure 1. Pathological examination results (Original magnification: ×10).
图 2 两组无进展生存曲线比较
Figure 2. Comparison of progression-free survival curves between the two groups.
表 1 两组治疗后近期疗效比较
Table 1. Short-term efficacy of two groups after treatment[n=55, n(%)]
组别 完全缓解 部分缓解 疾病稳定 疾病进展 总有效率 放化疗组 28(50.91) 19(34.55) 6(10.91) 2(3.64) 47(85.45) 放疗组 23(41.82) 17(30.91) 11(20.00) 4(7.27) 40(72.73) Z/χ2 1.37 2.69 P > 0.05 > 0.05 
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表 2 两组治疗前后血清肿瘤标记物比较
Table 2. Comparison of serum tumor markers between the two groups before and after treatment (n=55, Mean±SD)
组别 时间 IGF-1(μg/L) VEGF(ng/L) SCC(ng/mL) CEA(ng/mL) 放化疗组 治疗前 258.24±40.15 379.12±68.23 2.16±0.37 30.48±5.72 治疗后 83.57±13.26*△ 246.51±43.11*△ 0.92±0.15*△ 12.63±2.15*△ 放疗组 治疗前 256.95±38.79 383.04±69.57 2.23±0.41 29.75±5.69 治疗后 129.12±20.53* 310.25±56.48* 1.47±0.26* 23.19±4.28* *P < 0.05 vs治疗前；△P < 0.05 vs放疗组治疗后.
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表 3 两组毒副反应比较
Table 3. Comparison of toxic and side effects between the two groups[n=55, n(%)]
毒副反应 放疗组 放化疗组 Ⅰ级 Ⅱ级 Ⅲ级 Ⅳ级 Ⅰ级 Ⅱ级 Ⅲ级 Ⅳ级 胃肠道不适 27(49.09) 14(25.45) 3(5.45) 0(0.00) 22(40.00) 17(30.91) 11(20.00) 1(1.82) 肝功能损伤 23(41.82) 12(21.82) 4(7.27) 0(0.00) 20(36.36) 8(14.55) 14(25.45) 0(0.00) 放射性肺炎 8(14.55) 3(5.45) 2(3.64) 0(0.00) 7(12.73) 3(5.45) 3(5.45) 0(0.00) 放射性食管炎 25(45.45) 12(21.82) 1(1.82) 0(0.00) 23(41.82) 10(18.18) 2(3.64) 0(0.00) 周围神经毒性 3(5.45) 1(1.82) 1(1.82) 0(0.00) 2(3.64) 1(1.82) 1(1.82) 0(0.00) 骨髓抑制 33(60.00) 17(30.91) 5(9.01) 0(0.00) 28(50.91) 19(34.55) 8(14.55) 0(0.00)
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表 4 两组生存情况比较
Table 4. Comparison of survival status between the two groups [n=55, n(%)]
组别 1年生存率 2年生存率 3年生存率 放化疗组 40(72.73) 29(52.73) 22(40.00) 放疗组 37(67.27) 18(32.73) 10(18.18) χ2 0.390 4.495 6.346 P 0.533 0.034 0.012
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