血液低剂量辐射刺激疗法在消化系统癌症综合治疗中的应用研究

目的:探讨血液低剂量辐射刺激疗法(BLIT)在消化系统癌症综合治疗中的作用.方法:235例确诊的消化系统癌症,随机分研究组-BLIT+综合治疗(117例)、对照组-单纯综合治疗(118例),观察两组血象变化、免疫功能变化、急性放射性炎症防治、癌痛及肝癌治疗情况.结果:WBC降低Ⅰ-Ⅱ级者,研究、对照两组发生率分别为65.8%(77/117)、49.2%(58/118)(P<0.01);Ⅲ-Ⅳ级者,两组发生率分别为17.1%(20/117)、42.4%(51/118)(P<0.05).研究组82.5%(80/97)的血象(WBC.PLT)降低者在1-3d内恢复正常,对照组73.4%(80/109)的血象降低者在3-10d内恢复.BLIT前后,T细胞亚群及IL-2显著改善(P均<0.01).研究、对照两组急性放射性消化系统炎症发生率分别为6.84%(8/117)、21.2%(25/118)(P<0.01);发生炎症时两组放疗耐受量为4928±809(CGY)、2516±298(CGY)(P<0.01);两组呕吐率分别为10.3%(12/117),58.5%(70/118)(P<0.005);严重腹泻者,两组分别为0.85%(1/117)、8.5%(10/118)(P<0.005).研究、对照两组癌痛完全缓解率分别为70%(28/40)、11.1%(5/45)(P<0.005):4例肝癌行BLIT治疗,存活9—12mo.结论:在消化系统癌症综合治疗中,BLIT可显著防治骨髓抑制引起的血象降低并可保护胃肠黏膜功能,防治急性放射性炎症,减少严重胃肠反应;BLIT的显著提高机体免疫功能,是BLIT发挥作用的重要物质基础.在缓解癌痛、治疗肝癌方面,BLIT作用也很显著.

Checkpoint inhibitors in gastrointestinal cancers:Expectations and reality

Immune checkpoint inhibitors represent revolutionary anti-cancer agents, being rapidly approved in different malignancies and settings. Gastrointestinal(GI) cancers represent a wide variety of tumors with specific characteristics and different responses to various therapeutic alternatives; while some are chemosensitive others are chemo-resistant and only respond to more aggressive cytotoxic regimens, targeted therapies or a combination of both. Preliminary results of immune checkpoint inhibitors in some GI cancers are promising, namely in hepatocellular carcinoma, anal cancers and microsatellite instability high colorectal cancers. An impressive instead of a impressive number of immune checkpoint inhibitors are being evaluated in different indications in GI cancers as single agents or in combination with other agents. We reported in this paper ongoing and published trials evaluating immune checkpoint inhibitors in hepatocellular carcinoma and biliary tract cancers, esophageal, gastric, pancreatic, colorectal and anal cancers and we discussed the future perspectives of these agents in GI cancers.