小剂量阿帕替尼联合同步放化疗治疗老年食管癌的安全性评价及近期疗效

Safety and short-term efficacy of low-dose apatinib combined with concurrent chemoradiotherapy in elderly patients with esophageal carcinoma

目的探索小剂量阿帕替尼联合同步放化疗治疗老年食管癌的安全性及近期疗效。方法选取2019年8月至2021年7月蚌埠医学院附属阜阳医院初治的11例Ⅱ-ⅣA期的老年食管癌患者,治疗方案为小剂量阿帕替尼(放疗期间250 mg口服,每天1次)联合同步放化疗,化疗方案为雷替曲塞3 mg/m^(2),第1天+奈达铂75 mg/m^(2),第2天,放疗方法为调强放疗(95%PGTV 60Gy/30f/6w),观察治疗过程中的不良反应,评价近期疗效。结果11例患者治疗过程中,1例因放射性肺炎伴肺部感染而终止治疗,完成治疗的10例患者根据CTCAE5.0版标准及RTOG分级标准评价不良反应,其中血液系统毒副作用有白细胞减少7例(70%)、中性粒细胞减少5例(50%)、血红蛋白减少3例(30%);非血液毒性有高血压1例(10%)、转氨酶升高1例(10%)、胆红素升高1例(10%)、皮疹1例(10%)、放射性食管炎7例(70%)、放射性肺炎1例(10%),3级不良反应仅为白细胞减少1例,其余不良反应均为1~2级,所有不良反应予以对症处理后均好转,无4级不良反应,无药物相关死亡;根据RECIST1.1标准评价近期疗效,10例患者完全缓解(CR)3例(30%),部分缓解(PR)6例(60%),疾病稳定(SD)1例(10%),客观缓解率为90%,疾病控制率为100%。结论小剂量阿帕替尼联合同步放化疗在老年食管癌治疗中显示出良好的疗效和较高的安全性。

Objective To explore the safety and short-term efficacy of low-dose apatinib combined with concurrent chemoradiotherapy in elderly patients with esophageal carcinoma.Method A total of 11 patients with stageⅡ-ⅣA esophageal cancer were enrolled from August 2019 to July 2021.The treatment regimen was low dose apatinib(250 mg po qd)combined with concurrent chemoradiotherapy,the chemotherapy regimen was raltitrexed 3 mg/m^(2) d1+nedaplatin 75 mg/m^(2) d2.The intensity modulated radiation(95%PGTV 60Gy/30f/6w)was used to observe the adverse reactions and evaluate the short-term efficacy.Result During the treatment of11 patients,1 patient was terminated due to radiation pneumonitis with pulmonary infection,and 10 patients completed the treatment according to CTCAE5.0 and RTOG were used to evaluate the adverse reactions,including leukopenia in 7 cases(70%),neutrophil reduction in 5 cases(50%)and hemoglobin reduction in 3 cases(30%).Non-hematotoxicity included hypertension in 1 case(10%),transaminase in 1 case(10%),bilirubin in 1 case(10%),skin rash in 1 case(10%),radiation esophagitis in 7 cases(70%)and radiation pneumonitis in 1 case(10%),grade 3 adverse reaction was leukopenia in 1 case,and the other adverse reactions were grade 1-2.All adverse reactions were improved after symptomatic treatment,no grade 4 adverse reaction and no drug-related death.1 the short-term efficacy was evaluated by standard.3 patients had complete remission(CR)(30%),6 patients had partial remission(PR)(60%),1 patient had stable disease(SD)(10%),the objective remission(ORR)was 90%,and the disease control(DCR)was 100%.Conclusion Low-dose apatinib combined with concurrent chemoradiotherapy in the treatment of elderly esophageal cancer shows good efficacy and high safety,it is worth to expand the sample size for further study.