摘要
目的高强度聚焦超声(high intensity focused ultrasound,HIFU)同步吉西他滨化疗联合树突状细胞-细胞因子诱导的杀伤细胞免疫疗法(dendritic cells-cytokine-induced killer cell immunotherapy,DC-CIK)治疗中晚期胰腺癌的临床疗效及不良反应。方法 20例中晚期胰腺癌患者先行HIFU同步吉西他滨化疗,序贯DC-CIK免疫治疗。吉西他滨800~1 000 mg/m2,d1、d8,3周为1个周期,共4~6个周期。HIFU和化疗同步进行,5次/周,治疗2周间歇1周,共治疗4周。结果 CD3+CD4+T淋巴细胞、CD3+CD8+T淋巴细胞和CD56+自然杀伤(natural killer,NK)细胞比例及CD4+/CD8+细胞比率治疗前、后比较,差异均具有统计学意义(均P<0.05)。疼痛缓解率为73.3%。治疗前、后疼痛评分分别为(5.07±2.55)和(2.00±1.36),KPS评分分别为(73.00±6.57)和(85.5±10.50),治疗前、后疼痛评分及KPS评分比较,差异均具有统计学意义(均P<0.05)。所有患者部分缓解10例,疾病稳定5例,疾病进展5例,总有效率为50.0%。中位生存期为14个月,1年总生存率为62.7%,中位无进展生存期为8个月,1年无进展生存率为11.4%。不良反应为中性粒细胞减少Ⅰ级8例、Ⅱ级8例、Ⅲ级4例,血小板减少Ⅰ级5例、Ⅱ级2例、Ⅲ级1例,恶心、呕吐Ⅰ级15例、Ⅱ级5例。结论对于中晚期胰腺癌患者,HIFU同步吉西他滨化疗联合DC-CIK细胞治疗可缓解疼痛,提高生活质量,疗效确切,不良反应可以耐受。
Objective To evaluate the clinical efficacy and adverse effects of high intensity focused ultrasound( HIFU) combined with concurrent gemcitabine chemotherapy and dendritic cell-cytokine induced killer cell immunotherapy( DC-CIK) in the treatment of advanced pancreatic cancer. Methods Twenty patients with advanced pancreatic cancer were enrolled in the study. All patients were treated with HIFU and concurrent gemcitabine,followed by DC-CIK immunotherapy. Gemcitabine was administrated at 800-1 000 mg/m2 on d1 and d8 for 3 weeks as one cycle,and repeated for 4-6 cycles. HIFU was performed concurrently with the chemotherapy,for five times a week. One-week interval was scheduled after every 2-week HIFU treatment,with 4 weeks therapy in total. Results The percentages of CD3+CD4+T lymphocyte,CD3+CD8+T lymphocyte,CD56+NK cells and the ratio of CD4+/CD8+were changed significantly after the treatment,compared with those before the treatment( P 0. 05). The pain relief rate was 73. 3% and the pain scores were decreased from 5. 07 ± 2. 55 to 2. 00 ± 1. 36; the KPS scores were increased from 73. 00 ± 6. 57 to 85. 5 ± 10. 50 after treatment( both P 0. 05). Among 20 patients,10 achieved PR,5 were SD,and 5 were PD,with an overall effective rate of 50%. The medium survival time and the medium progression-free survival were 14 months and 8 months respectively; the 1-year survival rate and 1-year progression-free survival rate were 62. 7% and 11. 4% respectively. The adverse effects included: grade Ⅰneutropenia( n = 8),grade Ⅱ neutropenia( n = 8),grade Ⅲ neutropenia( n = 4); grade Ⅰ thrombocytopenia( n = 5),grade Ⅱ thrombocytopenia( n = 2),grade Ⅲ thrombocytopenia( n = 1); grade Ⅰ nausea/vomiting( n = 15),and grade Ⅱnausea/vomiting( n = 5). Conclusion HIFU combined with concurrent gemcitabine and sequential DC-CIK can relieve the pain and enhance the quantity of life in advanced pancreatic cancer patients,with significant clinical effects and tolerable adverse reactions.
作者
许涛
景红霞
曹风军
雷金华
邰云燕
李勇
狄全书
度龙
向龙超
Xu Tao;Jing Hongxia;Cao FengjunI;Lei Jinhua;Tai Yunyan;Li Yong;Di Quanshu;Duo Long;Xiang Longchao(Department of Oneology,Affiliated People's Hospital,Hubei University of Medicine,Shiyan 442000,China;Department of Ultrasonography,Affiliated People's Hospital,Hubei University of Medicine,Shiyan 442000,China)
出处
《实用肿瘤杂志》
CAS
2018年第5期416-420,共5页
Journal of Practical Oncology
基金
湖北省教育厅科学研究计划指导性项目(B2015471)
十堰市科学技术研究与开发项目(16Y46
14Y36)
十堰市人民医院青年英才项目(14-7)
关键词
胰腺肿瘤/治疗
超声
高强聚焦
经肠
树突细胞
杀伤细胞
抗肿瘤药/治疗应用
脱氧胞苷/治疗应用
脱氧胞苷/类似物和衍生物
治疗结果
pancreatic neoplasms/therapy
ultrasound
high-intensity focused
transrectal
dendritic cells
killercells
antineoplastic agents/therapeutic use
deoxycytidine/therapeutic use
deoxycytidine/analogs &derivatives
treatment outcome