加速超分割放疗联合PD-1抑制剂在小细胞肺癌诱导化疗后的应用价值

Application Value of Accelerated Hyperfractionated Radiotherapy Combined with PD-1 Inhibitor after Induction Chemotherapy for Small Cell Lung Cancer

目的:分析加速超分割放疗联合程序型死亡受体-1(PD-1)抑制剂在小细胞肺癌(SCLC)诱导化疗后的应用价值。方法:回顾性选取2021年4月—2023年3月新余市人民医院收治的82例SCLC患者的临床资料,依据治疗方式分为观察组(n=42)、对照组(n=40),对照组采用依托泊苷+顺铂/卡铂(EP)或者伊立替康+顺铂/卡铂(IP)方案进行诱导化疗,同时联合加速超分割放疗,观察组在对照组基础上联合新型PD-1抑制剂。对比两组临床疗效及治疗前后血清肿瘤标志物、Karnofsky评分、生存情况与不良反应发生情况。结果:观察组客观缓解率(ORR)明显高于对照组,差异有统计学意义(P<0.05)。治疗后,两组血清胃泌素释放肽前体(ProGRP)、神经元特异性烯醇化酶(NSE)、细胞角蛋白-19的可溶性片段(Cyfra21-1)、癌胚抗原(CEA)水平均低于治疗前,且观察组均低于对照组,差异均有统计学意义(P<0.05)。治疗后1、6、12个月,两组Karnofsky评分均高于治疗前,且观察组Karnofsky评分均高于对照组,差异均有统计学意义(P<0.05)。观察组1年内无进展生存率、总生存率均略高于对照组,但差异均无统计学意义(P>0.05)。两组各项不良反应发生率比较,差异均无统计学意义(P>0.05)。结论:加速超分割放疗联合PD-1抑制剂用于SCLC患者诱导化疗后,可明显地提高临床疗效,下调肿瘤标志物水平,安全可靠。

Objective:To analyze the application value of accelerated hyperfractionated radiotherapy combined with programmed death receptor-1(PD-1)inhibitor after induction chemotherapy in small cell lung cancer(SCLC).Method:Clinical data of 82 SCLC patients admitted to Xinyu People's Hospital from April 2021 to March 2023 were retrospectively selected,and divided into observation group(n=42)and control group(n=40)according to treatment methods.The control group received induction chemotherapy with Etoposide+Cisplatin/Carboplatin(EP)or Irinotecan+Cisplatin(IP)regimen combined with accelerated hyperfractionation radiotherapy,the observation group was combined with new PD-1 inhibitor on the basis of control group.The clinical efficacy,serum tumor markers,Karnofsky score before and after treatment,survival and adverse reactions were compared between the two groups.Result:The short-term objective response rate(ORR)in the observation group was significantly higher than that in the control group,the difference was statistically significant(P<0.05).After treatment,serum levels of pro-gastrin releasing peptide(ProGRP),neurone-specific enolase(NSE),soluble fragment of cytokeratin-19(Cyfra21-1)and carcinoembryonic antigen(CEA)in two groups were lower than those before treatment,and those in observation group were lower than those in control group,the differences were statistically significant(P<0.05).At 1,6 and 12 months after treatment,the Karnofsky scores of the two groups were higher than those before treatment,and the Karnofsky scores of the observation group were higher than those of the control group,the differences were statistically significant(P<0.05).The progression-free survival rate and overall survival rate during the past year in the observation group were slightly higher than those in the control group,but there were no statistical significance between the two groups(P>0.05).There were no significant differences in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Accelerated hyperfractionated radiotherapy combined with PD-1 inhibitor for induction chemotherapy in SCLC patients can significantly improve the clinical efficacy,reduce the level of tumor markers,and is safe and reliable.