伽马刀联合紫杉醇对局部淋巴结转移性食管癌患者的临床疗效

Clinical efficacy of gamma knife combined with taxol on esophageal carcinoma for patients complicated with loco-regional lymph node metastasis after radiotherapy

目的观察经过放疗后出现局部淋巴结转移的食管鳞癌(无远处淋巴结转移)患者接受伽马刀联合化疗(紫杉醇+奈达铂)的临床疗效并记录不良反应。方法收集符合临床研究标准的完成临床研究且临床资料数据可靠的85例无远处淋巴结转移的行根治性放疗(放疗后出现局部淋巴转移)的食管鳞癌患者,随机分为对照组(n=45)与观察组(n=40)。对照组患者给予伽马刀治疗,观察组在对照组的基础上给予化疗(紫杉醇+奈达铂),连续治疗4个疗程(1个疗程4周)。治疗结束后比较两组患者的临床疗效,肿瘤标记物浓度[高迁移率蛋白B1(HMGB1)、癌胚抗原(CEA)及鳞状上皮细胞癌抗原(SCC-Ag)水平]、免疫学指标,并记录不良反应。结果治疗后观察组近期临床疗效均优于对照组,但差异无统计学意义(P>0.05);远期临床疗效观察组优于对照组,差异有统计学意义(P<0.05)。治疗前两组患者的肿瘤标记物浓度(HMGB1、CEA、SCC-Ag)、免疫学指标差异均无统计学意义(P>0.05)。治疗后两组患者的免疫学(细胞免疫、体液免疫)指标均优于治疗前,差异有统计学意义(P<0.05),且观察组优于对照组,差异有统计学意义(P<0.05);治疗后两组患者的HMGB1、CEA、SCC-Ag均低于治疗前,差异有统计学意义(P<0.05),且观察组低于对照组,差异有统计学意义(P<0.05)。两组患者治疗过程中均出现放射性肺炎、放射性食管炎、骨髓抑制、消化道反应等不良反应,两组发生率差异无统计学意义(P>0.05)。结论经根治放疗后出现局部淋巴结转移的食管癌患者给予伽马刀+化疗能很好地提高有效率。

Objective To observe the clinical efficacy of gamma knife combined with chemotherapy（ paclitaxel and nedaplatin） on esophageal carcinoma of patients complicated with loco-regional lymph node metastasis after radiotherapy and to record the adverse reaction. Methods Eighty-five esophageal carcinoma patients without distant metastasis but with supraclavicular or mediastinal lymph node metastasis after radiotherapy were enrolled. They were randomly divided into control group（ n = 45） and observation group（ n = 40）. The control group were given with gamma knife,while observation group were given with chemotherapy（ paclitaxel and nedaplatin）. After 4 periods of treatment,the clinical efficacy and the high mobility protein B1（ HMGB1）,carcinoembryonic antigen（ CEA）,squamous cell carcinoma antigen（ SCC-Ag） levels and the immunity index（ cellular immunity and humoral immunity） were assessed. The adverse reactions were recorded. Results After treatment,short term clinical efficacy in observation group was better than control group,but the difference had no statistical significance（ P 〉 0. 05）. The long term clinical efficacy in observation group was significantly better than control group（ P 〈 0. 05）. Before treatment,there was no significant difference in the tumor marker（ HMGB1,CEA,and SCC-Ag）,or immunity index（ cellular immunity and humoral immunity） between the two groups（ P 〉 0. 05）. After treatment,the immunity index（ cellular immunity and humoral immunity） in the two groups were significantly better than those before treatment（ P 〈 0. 05）,and the observation group was significantly better than control group（ P 〈 0. 05）. After treatment,the tumor marker（ HMGB1,CEA,and SCC-Ag） in the two groups were significantly lower than before treatment（ P 〈 0. 05）,and those in observation group were significantly lower than control group（ P 〈0. 05）. During the treatment,hypoleukocytosis and thrombocytopenia,nausea,vomit,and et al. were recorded in both groups,while there was no significant difference between the two groups（ P 〉0. 05）. Conclusion Gamma knife combined with chemotherapy（ taxol ＋ cis-platinum） can improve the clinical efficacy on esophageal carcinoma patients complicated with loco-regional lymph node metastasis after radiotherapy.