低功率聚焦超声对胰腺癌化疗增敏作用的临床研究

Clinical research of the low-power HIFU on chemo-sensitivity enhancement effect in patients with advanced pancreatic cancer

目的:观察并评价低功率高强度聚焦超声(HIFU)对胰腺癌患者化疗的增敏作用。方法:选择胰腺癌患者30例,分成两组,试验组(GP方案化疗+低功率HIFU)与对照组(单纯GP方案化疗)各15例。观察并比较两组间治疗前后的临床症状、影像学(B超和/或CT)、实验室检查(肿瘤标志物CA199等)以及多药耐药相关基因表达(包括MDR1 mRNA、MRP mRNA、p53等)等变化情况。结果:试验组临床症状较对照组明显减轻(P<0.05),影像学可评价病灶:试验组CR 0例,PR 0例,SD 11例,PD 4例,DCR为73.3%;对照组CR 0例,PR 0例,SD 7例,PD 8例,DCR为46.7%,两组比较差异有显著性(P<0.05)。与治疗前相比,试验组治疗后MDR1 mRNA、MRP mRNA及p53表达水平显著降低(3.65±0.54与1.98±0.61,3.19±0.48与1.38±0.32,1.75±0.45与0.96±0.48;P<0.01),而对照组则无明显变化(3.87±0.68与4.09±0.63,3.18±0.53与3.27±0.45,1.81±0.51与1.99±0.56;P>0.05)。结论:低功率HIFU对胰腺癌化疗有一定增敏作用,有可能进一步提高疗效,改善患者的生活质量。

Objective：To observe and evaluate the low-power HIFU on chemo-sensitivity enhancement effect in patients with advanced pancreatic cancer.Methods：Thirty cases with advanced pancreatic cancer were divided into two groups,15 in the trial group（the low-power HIFU ＋ GP regimen） and 15 in the control group（GP regimen only）.GP regimen was given every 3 weeks for two cycles,and the low-power HIFU was 300-400W.All patients were assessable for the clinical symptom,imaging findings（B ultrasound or CT）,the peripheral blood CA199 and the expressions of multi-drug resistance-genes conaining MDR1 mRNA,MRP mRNA and p53 in the peripheral blood before and after chemotherapy.Results：The clinical symptoms of trial group was significantly than that of the control group after treatment（P 0.05）.The disease control rate（DCR） was 73.3% in the trial group and 46.7% in the control group,there were statistically significant differences between two groups（P 0.05）.The expression levels of MDR1 mRNA,MRP mRNA and p53 in the peripheral blood after treatment decreased significantly as compared with that before treatment in the trial group（3.65 ± 0.54 vs 1.98 ± 0.61,3.19 ± 0.48 vs 1.38 ± 0.32,1.75 ± 0.45 vs 0.96 ± 0.48;P 0.01）,but no significant differences in the control group（3.87 ±0.68 vs 4.09 ±0.63,3.18 ±0.53 vs 3.27 ± 0.45,1.81 ± 0.51 vs 1.99 ± 0.56;P 0.05）.The most frequent grade I/II treatment-related adverse events included diarrhea,nausea/vomiting and neutropenia.Conclusion：There is a certain sensitizing effect of the low power HIFU combined with chemotherapy in patients with advanced pancreatic cancer.