放射性^(125)I粒子支架联合介入化疗与普通支架治疗中、晚期食管癌的比较研究

Comparative Study of Radioactive ^(125)I Particle Stent Combined With Interventional Chemotherapy and Conventional Stent in the Treatment of Advanced Esophageal Cancer

目的探讨携带放射性^(125)I粒子食管内照射支架植入联合介入化疗治疗中晚期食管癌的安全性和疗效,并与单纯普通支架植入治疗比较。方法选择具备外科根治手术禁忌症或患者不愿意接受手术的中晚期食管癌患者32例作为研究对象。愿意接受放化疗15例患者作为研究组,即携带放射性^(125)I粒子食管内照射支架植入联合介入动脉化疗;不愿意接受放化疗17例患者作为对照组,即单纯普通支架植入治疗组。治疗后观察随访支架植入技术成功率、吞咽困难缓解率等近期疗效以及肿瘤分期改变情况、肿瘤标志物变化、远期疗效和近远期并发症,并对有效率、肿瘤分期改变情况、肿瘤标志物变化、并发症发生率及无进展生存期(progression-free survival,PFS)进行分析。结果两组在支架置入后,发热、胸痛、食管穿孔、出血等近期并发症等方面对比,差异无统计学意义(P>0.05)。两组患者支架移位及再狭窄等远期并发症对比,差异无统计学意义(P>0.05),但研究组患者术后再狭窄发生时间明显较对照组晚。研究组肿瘤分期和标志物降低程度均大于对照组(P<0.05);研究组平均PFS为(15.7±6.2)个月,对照组平均PFS为(6.8±4.9)个月,两组对比,差异有统计学意义(P<0.05)。结论携带^(125)I粒子食管内照射支架联合介入化疗治疗中晚期食管癌能明显缓解吞咽困难、降低肿瘤分期、改善患者生活质量和延长PFS,是安全、有效治疗方法。

Objective To evaluate the safety and therapeutic effect of stent with radioactive125I particles placement combined with interventional chemotherapy in treating patients with advanced esophageal carcinomas, and to compare with conventional self-expandable metal stent placement. MethodsChoose to have surgery contraindication or patients are not willing to accept surgery in 32 cases of advanced esophageal carmnoma, the patients were divided into study group （n=15） and control group （n=17）. Postoperative technical success rate, the change of tumor staging and tumor marker ,short-term and long-term results, remission rate of dysphagia, short-term complications and long-term complications were observed, and the effect rate, the change of tumor staging and tumor marker, the occurrence rate of complications , PFS were calculated and analyzed. ResultsNo signiifcant difference in the occurrence of fever, severe chest pain, esophageal perforation and hemorrhage existed between two groups （P〉0.05）. The difference in the occurrence of long-term complications such as stent migration or restenosis between two groups was not statistically signiifcant （P〉0.05）. The reduction degree of tumor staging, tumor marker in the study group was signiifcantly higher than that in the control group （P 〈0.05）. The mean PFS in the study group and in the control group was （15.7±6.2） months and （6.8±4.9） months respectively, the difference between two groups was statistically significant （P〈0.05）.ConclusionThis results of study indicate that for the treatment of advanced esophageal carcinomas the implantation of esophageal stent with radioactive125I particles combined with interventional chemotherapy can surely and markedly lower tumor staging, improve the qualily of life as well as prolong the patient＇s PFS and relive the symptom of dysphagia.