放化疗联合靶向治疗晚期胆道恶性肿瘤的临床观察

Efficacy of radio-chemotherapy combined with targeted therapy in patients with advanced biliary cancers

目的探讨放化疗联合靶向治疗不可切除胆道恶性肿瘤患者的临床价值和安全性。方法2007年1月—2010年12月，我科收治不可切除胆道恶性肿瘤患者12例，其中肝内胆管癌8例、下端胆管癌1例和胆囊癌3例。所有患者予伽马刀放疗（总量42—50Gy）；ZELOX方案化疗，21d为1个周期，最多6个周期（奥沙利铂130mg／m2，dl；卡培他滨2000mg／m2，d1～14）；每个化疗周期给予Bevaci-zumab（5mg／kg）。观察放化疗联合靶向治疗不可切除胆道恶性肿瘤的临床疗效、生存时间及毒副作用。结果12例患者均接受了放化疗和靶向治疗，中位化疗周期数4．5个，中位放疗剂量46Gy。随访患者全部死亡，中位随访时间为18．2个月，中位TTP7．25个月，中位生存期为14．6个月，其中CR0例，PR6例（50％），SD4例（33．3％），临床获益率83，3％，1年和2年生存率为58．3％和O％。放化疗联合靶向治疗不可切除胆道恶性肿瘤毒副作用轻微，多为1～2度，无患者因不良反应而中断治疗。结论放化疗联合靶向治疗不可切除胆道恶性肿瘤有一定的疗效，耐受性好。

Objective To observe the efficacy of radio-chemotherapy combined with targeted therapy in the patients with unresectable biliary cancers and its safety. Methods Twelve patients with unresectable biliary cancers, including 8 with intrahepatic cholangio- carcinoma, 1 with extrahepatic cholangiocarcinoma and 3 with gallbladder carcinoma, received both gamma-ray stereotaetic radio- therapy （total dosage up to 42 -50 Gy） and XELOX chemotherapy （oxaliplatin 130 mg/m2, day 1 ; capecitabine 2,000 mg/m2, day 1-14; regimen repetition every 21 days and no more than 6 cycles） from January 2007 to December 2010. Concurrent bevaei- zumab （5 mg/kg） was delivered to the patients in every cycle. The therapeutic efficacy, survival time and adverse reaction were re- corded. Results All the patients received radio-chemotherapy and targeted therapy. The median chemotherapy duration and the radiation dosage were 4.5 cycles and 46 Gy, respectively. They all died during the follow-up （ mean = 18.2 months）. The time to progression and the overall median survival were 7.25 and 14.6 months, respectively. Of the 12 patients, none reached complete response, 6 （50.0%） reached partial response and 4 （33.3%） reached stable diseases. The rate of required clinical benefit was 83.3%. The rates of 1-and 2-year survival were 58.3% and 0, respectively. With mild adverse effects （G1-2） , radio-chemother- apy combined with targeted therapy was tolerable. No patients had to give up the therapy due to toxicity. Conclusion Radio-chem- otherapy combined with targeted therapy showed a considerable anti-cancer effect on the patients with unresectable biliary cancers besides its well-tolerance.