重组人红细胞生成素结合高低氧对中晚期髓质型食管癌的放疗增敏作用

The study of radiosensitization of rhEPO combined with carbogen plus low concentration oxygen in middle-advanced medullary esophageal cancer

目的探讨重组人红细胞生成素(rhEPO)结合高低氧对中晚期髓质型食管癌放射治疗(放疗)的增敏作用及不良反应。方法将62例欲接受放疗的中晚期髓质型食管癌患者随机分为试验组和对照组。试验组:在放疗前1周给予rhEPO 30000U,皮下注射,每周1次,至放疗结束。放疗用6 MV X射线进行外照射,DT 1.8～2.0 Gy/次,每周5次,前后两野对穿照射DT 38～40Gy后,再两斜野对穿照射DT 20～30 Gy,中位剂量为DT 64 Gy。放疗过程中吸入高低氧。对照组单纯放疗,其射野和剂量同试验组,中位剂量为DT 66 Gy。结果放疗DT 20 Gy时,试验组完全消退率(CR)为10%,对照组CR为6.5%(P>0.05);放疗DT 40 Gy时,试验组CR为33.3%,对照组CR为16.1%(P>0.05);放疗结束时,试验组CR为53.3%,对照组CR为25.8%(P<0.05);放疗结束1个月后,试验组CR为66.7%,对照组CR为35.5%(P<0.05)。放疗结束时,Hb升高值试验组为17g/L,对照组为-3g/L(P<0.05);放疗结束1个月后,Hb升高值为试验组14g/L,对照组为2g/L(P<0.05)。两组的血液学毒性发生率分别为33.3%和61.3%,差异有统计学意义。结论rhEPO结合高低氧对中晚期髓质型食管癌有明显的放射增敏作用,血液学毒性较对照组轻微,并可预见能延长患者的远期生存,值得临床上进一步试用推广。rhEPO停用后1个月内仍有改善患者贫血的作用。

Objective To study the radiosensitization and side-effects of rhEPO combined with carbogen oxygen plus low concentration oxygen in middle-advanced medullary esophageal cancer. Methods From January 2004 to October 2005,62 cases of esophageal cancer were randomly divided into two groups,the trial group and the control group. In the trial group, rhEPO was administered at the dosage of 30000U weekly,in combination with carbogen oxygen plus low concentration oxygen throughout the course of radiation. The control group was given single radiotherapy. Radiation was administered with 6MV X-rays, 1.8--2.0Oy per day and 5 times per week. Total dose was 60-70Oy over 6-7 weeks, and the median doses to the trial group and the control group were 64Gy and 66Gy respectively. Results At the end of DT 20Oy, complete remission rate（CR） in the trial group was 10 % , whereas that in the control group was 6.5 % （ P〉0.05）, while DT 40Gy was over, the CR was 33.3 % and 16.1% （ P〉0.05） respectively,when the whole radiotherapy was finlshed,the CR was 53.3 % and 25.8 % （P 〈 0.05） respectively, and one month after radiotherapy, the CR was 66.7 % and 35.5 % respectively （P 〈 0.05 ）. At the end of whole radiotherapy,the improved Hb value was 17g/L and -3g/L respectively,and one month after radiotherapy, that was 14g/L and 2g/L. The acute hematological toxicity of two groups was 33.3 % and 61.3 % respectively（ P〈 0.05）. Conclusions The radiosensitization effect of rhEPO combined with carbogen oxygen plus low concentration oxygen in middle-advanced medullary esophageal cancer is obvious. The side-effects of trial group are less than those of the control group, and its elongating life time of patients may be prognostic, rhEPO can still improve anemia conditions of patients in a month after stopving administration.