HIFU联合吉西他滨同步化疗及DC-CIK治疗中晚期胰腺癌临床疗效分析

Clinical efficacy of HIFU combined with concurrent gemcitabine chemotherapy and DC-CIK in treatment of advanced pancreatic cancer

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.