Efficacy and CT manifestations of IMRT combined with chemotherapy in the treatment of esophageal cancer
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摘要:
目的 探究调强适形放疗（IMRT）技术同步化疗治疗食管癌的效果及CT表现。 方法 选取2020年5月~2021年5月重庆市开州区人民医院收治的134例食管癌患者，将其随机分为同步放化疗组（n=68）和联合调强适形放疗组（n=68），同步放化疗组给予三维适形放疗同步化疗，联合调强适形放疗组给予IMRT技术同步化疗。比较两组临床疗效和CT表现、免疫球蛋白[免疫球蛋白A（IgA）、免疫球蛋白M（IgM）、免疫球蛋白G（IgG）]、血管内皮生长因子（VEGF）及其受体1（VEGFR-1）、血清肿瘤标志物[癌胚抗原（CEA）、鳞状上皮细胞癌抗原（SCC-Ag）、糖类抗原125（CA125）]及不良反应。 结果 联合调强适形放疗组总有效率高于同步放化疗组（P < 0.05），CT可用于评估患者临床疗效；治疗后与同步放化疗组相比，联合调强适形放疗组IgA、IgM、IgG水平较高（P < 0.05），VEGF和VEGFR-1水平较低（P < 0.05），CEA、SCC-Ag、CA125水平较低（P < 0.05）；两组不良反应总发生率差异无统计学意义（P>0.05）。 结论 IMRT技术同步化疗治疗食管癌患者具有较好的疗效，对患者免疫球蛋白水平影响更小，还可下调VEGF和VEGFR-1水平，降低血清肿瘤标志物水平，安全性较好。 Abstract:Objective To investigate the efficacy and CT manifestations of intensity-modulated radiotherapy (IMRT) combined with chemotherapy in the treatment of esophageal cancer. Methods A total of 134 patients with esophageal cancer admitted to Chongqing Kaizhou District People's Hospital from May 2020 to May 2021 were selected. They were randomly divided into concurrent chemoradiotherapy group (n=68) and combined with intensity-modulated radiotherapy group (n=68). The concurrent chemoradiotherapy group was given three-dimensional conformal radiotherapy combined with chemotherapy, while the combined with intensity-modulated radiotherapy group was given IMRT combined with chemotherapy. The clinical efficacy and CT manifestations, immunoglobulin [immunoglobulin A (IgA), IgM and IgG], vascular endothelial growth factor (VEGF) and its receptor 1 (VEGFR-1), serum tumor markers (CEA, SCC-AG, CA125) and adverse reactions were compared between the two groups. Results The total effective rate of combined with intensity-modulated radiotherapy group was significantly higher than that of concurrent chemoradiotherapy group (P < 0.05). CT could be used to evaluate the clinical efficacy of patients. After treatment, compared with the concurrent chemoradiotherapy group, the levels of IgA, IgM and IgG in the combined with intensity-modulated radiotherapy group were significantly higher (P < 0.05), the levels of VEGF and VEGFR-1 were significantly lower (P < 0.05), and the levels of CEA, SCC-AG and CA125 were significantly lower (P < 0.05). There was no difference in the total incidence of adverse reactions between the two groups (P>0.05). Conclusion IMRT combined with chemotherapy has good efficacy in the treatment of esophageal cancer patients and less effect on the level of immunoglobulin. It can also down-regulate the levels of VEGF and VEGFR-1, reduce the level of serum tumor markers, and has good safety. -
图 1 患者1 IMRT技术同步化疗治疗前后CT图
A: 治疗前; B: 治疗后.
Figure 1. CT images of patient 1 before and after IMRT concurrent chemotherapy.
图 2 患者2 IMRT技术同步化疗治疗前后CT图
A: 治疗前; B: 治疗后.
Figure 2. CT images of patient 2 before and after IMRT concurrent chemotherapy.
图 3 患者3 IMRT技术同步化疗治疗前后CT图
A: 治疗前; B: 治疗后.
Figure 3. CT images of patient 3 before and after IMRT concurrent chemotherapy.
表 1 两组一般资料比较
Table 1. Comparison of general data between the two groups (n=68)
资料 联合调强适形放疗组 同步放化疗组 t/χ2/Z P 性别(n) 1.063 0.303 男 39 33 女 29 35 年龄（岁, Mean±SD） 52.25±9.20 53.12±8.87 0.561 0.576 临床分期(n) 0.284 0.777 Ⅰ期 24 18 Ⅱ期 27 37 Ⅲ期 17 13 病理类型(n) 0.766 0.382 鳞癌 63 60 腺癌 5 8 
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表 2 临床疗效比较
Table 2. Comparison of clinical efficacy [n=68, n(%)]
组别 总有效率 进展 稳定 完全缓解 部分缓解 联合调强适形放疗组 61（89.71） 7（10.29） 16（23.53） 18（26.47） 27（39.71） 同步放化疗组 52（76.47） 16（23.53） 21（30.88） 12（17.65） 19（27.94） χ2 4.239 P 0.040
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表 3 免疫球蛋白水平比较
Table 3. Comparison of immunoglobulin levels (g/L, n=68, Mean±SD)
组别 IgG IgA IgM 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 联合调强适形放疗组 11.40±1.24 10.08±0.95* 1.77±0.29 1.65±0.22* 1.54±0.16 1.45±0.12* 同步放化疗组 11.15±1.28 9.47±1.10* 1.73±0.32 1.45±0.18* 1.58±0.19 1.23±0.17* t 1.157 3.460 0.764 5.802 1.328 8.718 P 0.249 0.001 0.446 < 0.001 0.187 < 0.001 *P < 0.05 vs治疗前. IgG: 免疫球蛋白G; IgA: 免疫球蛋白A; IgM: 免疫球蛋白M.
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表 4 VEGF和VEGFR-1水平比较
Table 4. Comparison of VEGF and VEGFR-1 levels (ng/L, n=68, Mean±SD)
组别 VEGF VEGFR-1 治疗前 治疗后 治疗前 治疗后 联合调强适形放疗组 970.34±194.56 570.39±151.25* 120.25±33.37 96.94±21.17* 同步放化疗组 985.69±202.49 673.43±185.62* 124.48±30.52 106.65±25.52* t 0.451 3.549 0.771 2.415 P 0.653 0.001 0.442 0.017 *P < 0.05 vs治疗前. VEGF: 血管内皮生长因子; VEGFR-1: 血管内皮生长因子受体1.
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表 5 血清肿瘤标志物
Table 5. Serum tumor markers (n=68, Mean±SD)
组别 CEA（ng/mL） SCC-Ag（ng/mL） CA125（U/mL） 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 联合调强适形放疗组 29.72±5.10 20.25±4.56* 54.73±7.10 36.17±5.82* 82.25±17.59 31.52±10.12 同步放化疗组 30.22±5.05 24.59±4.80* 55.67±6.74 44.28±6.57* 81.02±16.51 49.54±15.86 t 0.574 5.406 0.792 7.619 0.420 7.899 P 0.567 < 0.001 0.430 < 0.001 0.675 < 0.001 *P < 0.05 vs治疗前. CEA: 癌胚抗原; CA125: 糖类抗原125; SCC-Ag: 鳞状上皮细胞癌抗原.
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表 6 不良反应比较
Table 6. Comparison of adverse reactions [n=68, n(%)]
组别 脱发 骨髓抑制 恶心呕吐 乏力 总发生率 联合调强适形放疗组 5（7.35） 3（4.41） 6（8.82） 5（7.35） 19（27.94） 同步放化疗组 7（10.29） 4（5.88） 4（5.88） 6（8.82） 21（30.88） χ2 0.142 P 0.707
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