阿帕替尼联合放疗治疗骨转移癌的临床疗效观察

Clinic observation of bone metastasis treated with apatinib combined with radiotherapy

目的 探讨阿帕替尼联合放疗治疗骨转移患者的临床疗效及安全性.方法 回顾性分析安徽医科大学第一附属医院放疗科2016年4月至2017年2月收治的31例骨转移癌患者,均给予阿帕替尼500 mg/d联合骨转移灶的放疗（30～40 Gy/10～20 F）,直至患者出现疾病进展或不可耐受的不良反应,分析其疗效和安全性.结果 阿帕替尼联合放疗治疗骨转移癌的疼痛缓解总有效率为93.55％（29/31）.完全缓解（CR）8例,占25.81％;中度缓解（PR） 18例,占58.06％;轻度缓解3例,占9.68％;无效2例,占6.45％.疼痛缓解的中位起效时间为治疗开始后第6天,中位维持时间为7个月;骨转移灶的控制情况,CR 1例（3.23％）,PR 16例（51.61％）,疾病稳定13例（41.94％）,疾病进展1例（3.23％）,总控制率为96.78％;治疗后患者功能状态评分明显提高（83.71±5.77∶78.87±7.49）,差异具有统计学意义（t=4.23,P=0.006）;中位无进展生存期为6个月,中位总生存时间为7个月.常见的不良反应为高血压、手足综合征、蛋白尿和骨髓抑制,其中高血压发生率为35.48％（11/31）,手足综合征发生率为25.81％（8/31）,蛋白尿发生率为16.13％ （5/31）,骨髓抑制发生率为16.13％（5/31）.结论 阿帕替尼联合放疗治疗骨转移癌患者具有良好的疗效和安全性.

 Objective To evaluate the clinical efficacy and safety of apatinib combined with radiotherapy in patients with bone metastasis.Methods Thirty-one patients admitted to Radiation Oncology of the First Affiliated Hospital of Anhui Medical University with bone metastasis were recruited from April 2016 to February 2017.All patients were received apatinib 500 mg/d orally combined with radiotherapy （30 ～40 Gy/10 ～20 F）.until disease progression or intolerable toxicity occurred.Clinical efficacy and safety were observed.Results The total response rate was 93.55% （29/31）,25.81% （8/31） had complete response,58.06% （18/31） had moderate response,9.68% （3/31） had mild response,and 6.45% （2/31） had no response;The time to exert its effect after the treatment was 6 days,and its median maintenance time was 7 months.The lesions complete response was 3.23% （1/31）,partial response was 51.61% （16/31）,became stable in 13 patients （41.94%）,and deteriorated in 1 patient （3.23%）,and the total control rate was 96.78%.The patients Karnofsky score increased obviously after the treatment （83.71 ± 5.77 vs.78.87 ± 7.49）,and the difference was statistically significant （t =4.23,P =0.006）.The median local progression-free survival and median overall survival were 6 months and 7 months,respectively.The main adverse reactions were hypertension,hand-foot syndrome,proteinuria and bone marrow depression.The rates of hypertension,hand-foot syndrome,proteinttria and bone marrow depression were 35.48% （11/31）,25.81% （8/31）,16.13% （5/31）,and 16.13% （5/31）,respectively.Conclusion Radiotherapy combined with apatinib is effective and tolerable for bone metastasis patients.