放化同期治疗对局部晚期非小细胞肺癌外周血VEGF的影响及意义

Effect and significance of concurrent chemo-radiotherapy on serum VEGF in locally advanced non-small cell lung cancer

目的比较放化同期治疗和放化序贯治疗对局部晚期非小细胞肺癌外周血血管内皮生长因子(VEGF)的影响。方法 2010年1月至2012年12月,64例经病理确诊的ⅡB至ⅢB期的非小细胞肺癌患者各32例,A组采用三维适形放疗及同期EP或TC方案化疗,B组接受三维适形放疗后序贯EP或TC方案化疗。在放射治疗前、放疗开始1个月和治疗后(两组均完成放化疗后)采用酶联免疫法检测VEGF,比较两组患者的中VEGF动态变化情况。结果 A、B两组缓解率分别为90.6%和68.8%;A组近期治疗有效率明显优于B组(χ2=4.7300,P=0.0296)。在放射治疗前,A组和B组的VEGF分别为(212.65±43.24)Pg/ml和(218.81±54.81)Pg/ml,差异无统计学意义(t=0.4491,P=0.6194)。放疗开始一个月分别为(160.36±44.39)Pg/ml和(243.63±36.32)Pg/ml,差异有统计学意义(t=8.2128,P=0.0000)和治疗后分别为(97.53±15.48)Pg/ml、(102.31±27.74)Pg/ml,差异无统计学意义(t'=0.8512,P>0.05)。同时发现A组在治疗30 d时VEGF水平显著下降,而B组则出现了显著的上升(P<0.05)。结论放化同期治疗能够有效降低单纯放疗诱导的局部晚期肺癌外周血VEGF的表达,提示同期化疗能够通过抑制VEGF水平进而降低VEGF相关的肿瘤放射抵抗和放疗野外肿瘤的增殖和转移。

Objective To compare the effect and the significance of concurrent chemo-radiotherapy on se- rum VEGF in locally advanced non-small cell lung cancer （NSCLC）. Methods From 2010 January to 2012 Decem- ber, 64 patients with pathologically confirmed IIB and III B stage non small cell lung cancer, were divided randomly in- to concurrent chemoradiotherapy group （group A） and sequential therapy group （group B）. Group A was treated with three-dimensional eonformal radiotherapy and concurrent chemotherapy with TC or EP. Group B received EP or TC regimen chemotherapy after three-dimensional conformal radiotherapy. ELISA was used to detect serum VEGF and compare the dynamic changes of VEGF on those patients from preradiotherapy, radiotherapy in one month to post-treatment. Results The remission rates in group A, B were 90.6% and 68.8%; the effective rate of treatmen in group A was better than that of B （Xz---4.7300, P---0.0296）. The VEGF level of group A and B were （212.65＋43.24） Pg/ml and （218.81 ＋54.81） Pg/ml, with no significant difference before radiotherapy, （160.36-v44.39） Pg/ml and （225.58：1： 49.96） Pg/ml radiotherapy in one month, with significant difference （t=5.5204, P=0.0000）, and （97.53~ 15.48） Pg/ml and （102.31 ~27.74） Pg/ml after treatment, with no significant difference. Meanwhile, the VEGF levels in group A de- creased significantly, while group B had significantly increased in the treatment of 30 days （P〈0.05）. Conclusion Con- current chemoradiotherapy is more effective than the sequential therapy in reducing serum VEGF level in locally ad- vanced NSCLC, which suggests that the concurrent chemotherapy can inhibit the rad＇ation-induced VEGF level increas- ing and then to reduce VEGF related tumor radiation resistance, proliferation and metastasis outside the radiation field.