重组人血管内皮抑制素促进子宫颈鳞状细胞癌放疗效果的临床观察

Endostatin improves the effect of radiotherapy in the treatment of squamous carcinoma of the uterine cervix

目的:探讨重组人血管内皮抑制素(恩度)注射液联合放疗治疗中晚期子宫颈癌的临床疗效。方法:将60例中晚期子宫颈癌患者随机分为两组:恩度联合放疗组(观察组)和常规放疗组(对照组),每组30例。两组患者均采用体外照射和腔内后装治疗,同时观察组采用恩度[7.5mg/(m2.d)]+500ml生理盐水静脉滴注3～4h,连续14d,停用7d,为1周期。分别于治疗前,治疗1、2、3、4周时通过CT扫描检测肿瘤的血管影像参数,分析放疗后的近期疗效。结果:①观察组患者的肿瘤血管迂曲、膨胀程度减轻,分布趋于均匀,呈现出不同程度的正常化,以治疗后第1周最为明显,其组织血流量、血容量以及平均血流通过时间均大于治疗前(P<0.05),第2、3、4周后的血管影像参数与第1周治疗后比较无差别(P>0.05);对照组患者的肿瘤血管形态和分布规律在治疗后出现明显变化,其组织血流量、组织血容量以及平均通过时间在治疗后明显升高(P<0.05),但升高幅度不如观察组明显(P<0.05)。②观察组患者5年生存率、复发率、无进展生存率与对照组比较差异均有统计学意义(P<0.05)。结论:放疗是积极治疗中晚期子宫颈癌的有效手段,重组人血管内皮抑制素注射液联合放疗可提高治疗效果。

Objective： To study the clinical efficacy of the combination of radiotherapy and endostatin injection in the treatment of moderate and advanced squamous carcinoma of the uterine cervix. Methods ： Sixty patients with moderate and advanced cervical cancer were randomized divided into two groups ： experiment group （ n = 30, treated with endostatin plus radiotherapy） and control group （ n = 30, treated with radiotherapy alone）. The radiotherapy in all patients was extraeorporeal irradiation and intracavitary afterloading therapy. Endostatin （7.5mg/m^2 · d） was intravenously given for consecutive 14 days, followed by a 7 - day interval of rest, as a treatment cycle. The tumor vascular imaging parameters were detected by CT scan before treatment and 1,2,3,4 weeks after treatment, respectively, to assess the short - term efficacy of the treatment. Results： （ 1 ） In the experiment group, the degree of tumor vascular tortuosity and swelling was reduced, and the distribution of tumor vasculum was more evenly, showing different degrees of normalization, which was more evident at the first week after treatment. The tissue blood flow, blood volume, and mean transit time after treatment were significantly greater than those before treatment （P〈 0.05 ）. These changes were even more evident in the first week of treatment, but not significantly different from those of the later weeks （ P 〉 0.05 ）. （2） In the control group, the tumor vascular morphology and distribution pattern had apparent changes after treatment, and the tissue blood flow, tissue blood volume, and mean transit time after treatment were significantly higher than those before treatment （P 〈 0.05）. But the degree of these changes was significant lower than that of experiment group （ P 〈 0.05 ）. （3） There was a significant difference in the 5 - year survival rate, recurrence rate and progression - free survival rate, respectively, between two groups （P 〈 0.05 ）, with the better efficacy in experiment group. Conclusion： The radiotherapy is a positive means for the treatment of moderate and advanced cervical cancer, and endostatin injection could improve the effect of radiotherapy.