调强放疗联合甲磺酸阿帕替尼治疗老年局部晚期贲门癌患者效果及对血管内皮生长因子受体的影响

Efficacy of intensive radiotherapy combined with mesylate apatinib for treatment of elderly patients with locally advanced cardia cancer and its effect on vascular endothelial growth factor receptor

目的观察调强放疗（IMRT）联合甲磺酸阿帕替尼治疗老年局部晚期贲门腺癌患者的临床效果及对血管内皮生长因子受体（VEGFR）的影响。方法收集2015年1月至2016年4月江苏大学附属徐州医院收治的局部晚期、手术无法切除或不愿手术的老年贲门癌患者46例，按照随机数字表法分为对照组及观察组各23例。对照组行单纯放疗，观察组放疗第1天开始早餐后口服甲磺酸阿帕替尼500 mg/d，直至病情进展或死亡。结果观察组治疗总有效率为92%（19/23），对照组为60%（10/23），差异有统计学意义（χ^2=5.86，P〈0.05）。治疗后两组VEGFR水平均下降，观察组下降更明显，差异有统计学意义[（76.3±4.9）比（55.0±2.3）pg/ml，t=3.93，P〈0.05]。常见的不良反应为血液学不良反应和胃肠反应，两组胃肠反应发生率均为83%，血液学不良反应发生率均为100%，差异均无统计学意义（均P〉0.05）；观察组出现高血压、蛋白尿、皮疹，两组均未出现Ⅳ级不良反应。观察组中位无进展生存时间为10个月，对照组为8个月，差异有统计学意义（P=0.01）。结论IMRT联合甲磺酸阿帕替尼治疗老年局部晚期贲门癌患者有效且耐受性好。

Objective To observe the clinical effect of intensity modulated radiation therapy （IMRT） combined with apapatinib mesylate in the treatment of elderly patients with locally advanced cardia adenocarcinoma and its effect on vascular endothelial growth factor receptor （VEGFR）.Methods Forty-six elderly patients with locally advanced cardia cancer who were unwilling to accept surgery or couldn＇t get complete removal of cancers in Xuzhou Hospital Affiliated to Jiangsu University between January 2015 and April 2016 were collected. All the patients were randomly divided into the control group （23 cases） and the observation group （23 cases） according to the random number table method. The control group received radiotherapy alone. In the observation group, oral apatinib （500 mg/d） was taken in the first day of radiotherapy after breakfast until the disease progress or death occurred.Results The total effective rate was 92% （19/23） in the observation group and 60% （10/23） in the control group. There was a significant difference between the two groups （χ^2= 5.86, P 〈 0.05）. After treatment, the average level of VEGFR in both groups was decreased [（76.3±4.9） vs. （55.0±2.3） pg/ml], and there was a significant difference between the two groups （t= 3.93, P 〈 0.05）. The common adverse reactions were blood adverse reactions and gastrointestinal reactions. The incidence rate of gastrointestinal reaction was both 83%, and the blood adverse reaction was 100%, and there was no significant difference between the two groups （both P 〉 0.05）. Hypertension, proteinuria and rash response in the observation group were increased compared with the control group, but no Ⅳ grade of adverse reactions occurred. The median progression-free survival time was 10 months in the observation group and 8 months in the control group respectively （P= 0.01）.Conclusion IMRT combined with apatinib in the treatment of elderly patients with locally advanced gastric cardia has a favorable efficacy and tolerance.