多西他赛联合顺铂同步调强放射方案治疗手术不耐受食管鳞癌老年患者的效果观察

Effect of TP simultaneous intensity modulated radiation regimen on elderly patients with surgical intolerance of esophageal squamous cell carcinoma

目的探讨多西他赛联合顺铂(TP)同步调强放射方案治疗手术不耐受食管鳞癌老年患者的效果。方法本研究为前瞻性研究,选取2018年9月至2020年10月郑州市第三人民医院肿瘤放疗科收治的123例手术不耐受的食管鳞癌老年患者,男67例,女56例,年龄(65.98±4.35)岁,年龄范围为60~72岁。按照随机数表法随机分为调强放射治疗(IMRT)组(n=61)和IMRT+TP组(n=62)。IMRT组单纯给予IMRT;IMRT+TP组在IMRT组治疗的基础上,联合TP方案同步化学治疗。观察两组的有效率、血清肿瘤标志物[糖类抗原125(CA125)、癌胚抗原、鳞状细胞癌抗原(SCCA)]水平、血管内皮细胞生长因子(VEGF)水平、金属蛋白酶[基质金属蛋白酶2(MMP2)、组织金属蛋白酶抑制剂2(TIMP2)、转移抑制基因nm23-H1]水平及不良反应发生率。结果IMRT+TP组有效率[62.9%(39/62)]高于IMRT组[44.3%(27/61)],差异有统计学意义(P<0.05)。IMRT+TP组治疗后的VEGF、SCCA、CA125、癌胚抗原水平[(136.62±30.01)pg/ml、(1.05±0.11)μg/L、(7.52±1.41)U/ml、(3.35±0.84)μg/L]均低于IMRT组[(176.52±29.84)pg/ml、(1.72±0.23)μg/L、(9.04±2.14)U/ml、(4.02±1.23)μg/L],差异均有统计学意义(P<0.05)。IMRT+TP组治疗后的MMP2阳性率[27.4%(17/62)]低于IMRT组[45.9%(28/61)],TIMP2和nm23-H1阳性率[90.3%(56/62)、85.5%(53/62)]高于IMRT组[78.7%(48/61)、70.5%(43/61)],差异有统计学意义(P<0.05)。两组患者不良反应的发生率比较,差异无统计学意义(P>0.05)。结论TP方案同步IMRT可通过下调手术不耐受食管鳞癌老年患者的VEGF水平,改善血清肿瘤标志物和金属蛋白酶水平,提高治疗有效率且不增加不良反应发生率。

Objective To investigate the effect of docetaxel combined with cisplatin(TP)in the treatment of elderly patients with esophageal squamous cell carcinoma who cannot tolerate surgery.Methods This study was a prospective study.A total of 123 elderly patients with esophageal squamous cell carcinoma who were intolerant to surgery were selected from September 2018 to October 2020 in the Department of Radiation Oncology,The Third People′s Hospital of Zhengzhou,including 67 males and 56 females.The age was(65.98±4.35)years old,ranged from 60 to 72 years old.According to the random number table method,they were randomly divided into intensity-modulated radiation therapy(IMRT)group(n=61)and IMRT+TP group(n=62).The IMRT group was given IMRT alone;the IMRT+TP group was given concurrent chemotherapy with the TP regimen on the basis of the IMRT group treatment.The effective rate,serum tumor markers[carbohydrate antigen 125(CA125),carcinoembryonic antigen,squamous cell carcinoma antigen(SCCA)]levels,vascular endothelial growth factor(VEGF)levels,metalloproteinase[matrix metal Protease 2(MMP2),tissue inhibitor of metalloproteinase 2(TIMP2),and metastasis suppressor gene nm23-H1]levels and incidence of adverse reactions.Results The effective rate of IMRT+TP group[62.9%(39/62)]was higher than that of IMRT group[44.3%(27/61)],and the difference was statistically significant(P<0.05).The levels of VEGF,SCCA,CA125 and carcinoembryonic antigen in IMRT+TP group after treatment[(136.62±30.01)pg/ml,(1.05±0.11)μg/L,(7.52±1.41)U/ml,(3.35±0.84)μg/L]were lower than the IMRT group[(176.52±29.84)pg/ml,(1.72±0.23)μg/L,(9.04±2.14)U/ml,(4.02±1.23)μg/L],the differences were all Statistical significance(P<0.05).The positive rate of MMP2[27.4%(17/62)]in the IMRT+TP group after treatment was lower than that in the IMRT group[45.9%(28/61)],and the positive rates of TIMP2 and nm23-H1[90.3%(56/62),85.5%(53/62)]higher than the IMRT group[78.7%(48/61),70.5%(43/61)],the difference was statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions TP regimen combined with IMRT can reduce the level of VEGF in elderly patients with esophageal squamous cell carcinoma intolerant to surgery,improve the levels of serum tumor markers and metalloproteinases,and improve the treatment efficiency without increasing the incidence of adverse reactions.