早期放疗联合EP和EC方案治疗局限期小细胞肺癌的临床对比研究

Comparison study of early radiotherapy combined with EP and EC therapy for limited-stage small cell lung cancer

目的研究早期放疗联合EP(足叶乙甙+顺铂)或EC(足叶乙甙+卡铂)方案治疗局限期小细胞肺癌(LSCLC)的临床效果、安全性及对血清Ki-67和血管内皮生长因子(VEGF)水平的影响。方法选取2013年1月～2014年12月解放军第九七医院放疗科收治的LSCLC患者70例,按随机数字表法分为EP组和EC组,每组各35例,EP组采用足叶乙甙+顺铂化疗,EC组采用足叶乙甙+卡铂化疗,21 d为1周期,共治疗6周期,同时在连续化疗2个周期后开始同步放疗,放化疗结束后评价近期临床疗效、不良反应,并对其生存期进行随访,同时采用酶联免疫吸附法检测两组治疗前后血清Ki-67和VEGF水平。结果 EP组有效率为71.43%,疾病控制率为85.71%;EC组有效率为68.57%,疾病控制率为80.00%,差异无统计学意义(P> 0.05)。EP组患者总生存期(OS)为21.6个月,1年生存率为74.29%;EC组患者OS为22.1个月,1年生存率为77.14%,差异无统计学意义(P> 0.05)。EP组骨髓抑制(中性粒细胞、血小板减少)发生率低于EC组(P <0.05),而在消化道反应、放射性肺炎、食管炎、肝功能异常等不良反应发生率较EC组差异无统计学意义(P> 0.05)。与治疗前比较,两组治疗后血清Ki-67和VEGF水平均明显降低,但EP组降低更明显(P <0.05)。结论早期放疗联合EP或EC方案对LSCLC患者近期疗效及生存情况的影响无明显差异,但早期放疗联合EP方案不良反应较轻,对血清Ki-67和VEGF水平影响更明显。

Objective To explore the clinical effect and security on early radiotherapy combined with EP or EC therapy for limited-stage small cell lung cancer （LSCLC） and the influence on levels of the serum Ki-67 and VEGF. Methods A total of 70 cases with LSCLC in Department of Radiotherapy, the 97th Hospital of People＇s Liberation Army from January 2013 to December 2014 were selected, and they were divided into EP group and EC group by the random num- ber table method, with 35 cases in each group. The EP group was treated with VP-16 and DDP, while EC group was treated with and VP-16 and CBP. A treating course was 21 days, and both groups were treated for 6 courses. Concurrent radiotherapy was initiated after 2 courses of continuous chemotherapy. The clinical effect and adverse reactions were evaluated; the survival time was followed up. The levels of serum Ki-67 and VEGF before and after treatment were tested via ELISA. Results In EP group, the effective rate was 71.43%, and the disease control rate was 85.71%, while in EC group, they were 68.57%, 80.00% respectively, and there was no significant difference （P 〉 0.05）. In EP group, the overall survival time （OS） was 21.6 months, the 1-year survival rate was 74.29%, while in EC group, the OS was 22.1 months, the 1-year survival rate was 77.14%, and there was no significant difference （P 〉 0.05）. The adverse reactions rate of bone marrow suppression （neutrophile granulocyte, platelet decrease） was lower in EP group, while rate of gastrointestinal reaction, radiation pneumonitis, oesophagitis, abnormal liver function between the two groups had no significant difference （P 〉 0.05）. Compared with the levels of Ki-67, VEGF before treatment, the levels of Ki-67, VEGF decreased remarkably in the two groups after treatment, while more obvious in EC group （P 〈 0.05）. Conclusion There is no significant difference with the short-term effect in LSCLC between EP or EC therapy combined with early radiotherapy treatment, but EP therapy has fewer adverse reactions, with more obvious effect on suppressing the levels of serum Ki-67 and VEGF.