同步加量调强放疗对中段食管癌患者肿瘤标志物及心肺功能的影响

Effects of Synchronous Intensity Modulated Radiotherapy on Serum Tumor Markers and Cardiopulmonary Function in Patients with Middle Esophageal Cancer

[目的]探讨同步加量调强放疗(simultaneous integrated boost intensity-modulated radiotherapy,SIB-IMRT)对中段食管癌患者疗效及心肺功能的影响。[方法]选取行SIB-IMRT放疗的中段食管癌患者103例,观察患者接受SIB-IMRT全疗程后1周血液中CEA、SCC和CYFRA21-1三项肿瘤标志物的变化,并进行疗效评价;运用心肺运动试验检测患者治疗后肺功能的变化,同时评估心脏毒性和放射性肺损伤程度,并统计患者接受治疗1年后的局部控制率以及总生存率。[结果]患者治疗后1周,CEA、SCC和CYFRA21-1三项肿瘤标志物均较治疗前显著下降(P<0.05),其中肿瘤标志物处于下降趋势的患者治疗有效率和疾病控制率均显著高于上升趋势患者(P<0.05)。心肺运动试验核心指标中,峰值摄氧量、峰值负荷功率、运动时间均较治疗前显著降低(P<0.05),CO_(2)通气当量斜率、最低值显著提高(P<0.05);循环系统指标中,在极限阶段摄氧量和公斤摄氧量显著降低(P<0.05),静息阶段心率、极限及恢复阶段CO_(2)通气当量明显提高(P<0.05);呼吸系统指标中,潮气末CO_(2)分压在静息、热身、无氧阈、极限及恢复阶段均较治疗前显著下降(P<0.05),热身、恢复阶段的O_(2)通气当量较治疗前显著提高(P<0.05),患者其余各项心肺运动试验指标及静态肺功能指标均较治疗前无显著差异(P>0.05)。经多普勒超声(TDI)检查,治疗后舒张早期峰值速度(Em)、二尖瓣口舒张早期血流速度/舒张早期峰值速度(E/Em)较治疗前明显降低(P<0.05),左心房容积指数(LAVI)较治疗前明显提高(P<0.05),其余各参数在治疗前后无明显变化(P>0.05),未发现有明显的心脏毒性。从开始放疗至放疗结束后1周,有17例患者发生放射性肺损伤,其发生率为16.50%(17/103)。103例患者局部控制率为56%,总生存率为75%。[结论]SIB-IMRT能有效降低食管癌患者CEA、SCC和CYFRA21-1水平,对患者的心肺损伤较小。

[Objective]To investigate the effect of simultaneous integrated boost intensity-modulated radiotherapy(SIB-IMRT)on serum tumor markers and cardiopulmonary function in patients with middle esophageal cancer.[Methods]One hundred and three patients with middle esophageal cancer who underwent SIB-IMRT were included.Serum CEA,SCC and CYFRA21-1 levels were measured,and cardiopulmonary exercise test(CPET)was performed before and 1 week after the whole course of SIB-IMRT.The local control rate and 1-year overall survival rate(OS)were evaluated.[Results]One week after treatment,CEA,SCC and CYFRA21-1 were significantly lower than those before treatment(P<0.05),the efficacy rate and disease control rate in patients with decreasing tumor marker levels were significantly higher than those with rising tumor marker levels(P<0.05).Compared with those before treatment,the CPET showed that in the core indexes including peak oxygen uptake,peak load power and exercise time were significantly decreased(P<0.05),the slope and minimum value of CO_(2) ventilation equivalent significantly increased 1 week after treatment(P<0.05);in the circulatory system indexes,the oxygen uptake and kilogram oxygen uptake decreased significantly(P<0.05),and the heart rate,CO_(2) ventilation equivalent in resting stage and recovery stage increased significantly after treatment(P<0.05);in the respiratory system indexes,the end tidal carbon dioxide partial pressure decreased significantly in the rest,warm-up,anaerobic threshold,limit and recovery stages(P<0.05),the O_(2) ventilation equivalent in the warm-up and recovery stages was significantly higher after treatment(P<0.05);while there was no significant difference in other CPET indexes and static pulmonary function indexes(P>0.05).Doppler ultrasound(TDI)showed that after treatment,Em,E/EM and LAVI were significantly lower than those before treatment(P<0.05),LAVI was significantly higher than those before treatment(P<0.05),and other parameters had no significant changes before and after treatment(P>0.05).No obvious cardiotoxicity was found after treatment.Up to 1 week after radiotherapy,17 patients developed radiation-induced lung injury,with an incidence of 16.50%(17/103).The local control rate was 56%,and the 1-year overall survival rate was 75%.[Conclusion]SIB-IMRT is effective for patients with middle esophageal cancer,which can reduce serum CEA,SCC and CYFRA21-1 levels with minor cardiopulmonary function injury.