沙利度胺联合累及野放疗治疗高龄(≥75岁)食管癌患者的临床观察  

Clinical Observation on the Over-75 Esophageal Carcinoma Patients Treated with Thalidomide Combined with Involved-Field Radiotherapy

作　　者：许之晨[1] 李建成[2] 苏宝安 陈炬辉[2] Xu Zhichen;Li Jianchen;Su Baoan;Chen Juhui(Department of Radiotherapy,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou 362000,Fujian,China;Department of Radiotherapy,Fujian Cancer Hospital Affiliated to Fujian Medical University,Fuzhou 350004,Fujian,China)

机构地区：[1]福建医科大学附属泉州市第一医院放疗科,福建泉州362000 [2]福建医科大学附属福建省肿瘤医院放疗科,福州350004

出　　处：《肿瘤预防与治疗》2022年第1期23-28,共6页Journal of Cancer Control And Treatment

基　　金：福建省卫生厅创新基金项目(编号:2016-CX-10)。

摘　　要：目的:观察累及野调强放疗加或不加沙利度胺对75岁以上食管癌患者的近期疗效、相关副反应及远期疗效影响。方法:回顾性分析于2017年1月至2018年12月在我院接受累及野照射(involved-field irradiation,IFI)且符合条件的高龄(≥75岁)食管癌患者,按是否加用沙利度胺分为单纯放疗组和联合治疗组。单纯放疗组仅接受IFI,联合治疗组则在接受IFI的基础上,从放疗第一日至放疗最后一日每日睡前口服沙利度胺100mg。收集其性别、年龄、肿瘤部位、分级等临床资料用于分析,并探讨其近期疗效、远期疗效、失败模式。结果:研究共收集到90例患者符合纳入排除标准,其中45例患者仅接受IFI(单纯放疗组),45例患者在IFI的基础上加用沙利度胺(联合治疗组)。联合治疗组与单纯放疗组相比,客观有效率(84.44%vs 77.77%;χ^(2)=0.653,P=0.419)、疾病控制率(97.77%vs 95.55%;χ^(2)=0.345,P=0.557)的差异无统计学意义;两组患者骨髓抑制的主要表现为白细胞减少,发生率的差异亦无统计学意义(26.67%vs 22.22%;χ^(2)=0.241,P=0.624)。联合治疗组放射性食管炎的发生率明显低于单纯放疗组(28.89%vs 55.56%;χ^(2)=6.559,P=0.010),且发生放射性食管炎的平均时间为放疗第(16.23±3.13)天,明显晚于单纯放疗组第(10.30±2.09)天,差异有统计学意义(t=5.070,P<0.001)。联合治疗组中,发生放射性食管炎的患者IL-6平均水平为(13.86±7.10)pg/mL,明显低于单纯放疗组(28.84±12.34)pg/mL,差异有统计学意义(t=4.218,P=0.001)。两组放射性肺炎的发生率差异无统计学意义(17.78%vs 22.22%;χ^(2)=0.278,P=0.598)。联合治疗组患者的1、2、3年生存率分别为77.8%、44.4%、26.7%,单纯放疗组患者的1、2、3年生存率分别为73.3%、37.7%、22.2%,差异无统计学意义(χ^(2)=2.127,P=0.145);联合治疗组患者的1、2、3年局部控制率分别为75.6%、40.0%、22.2%,单纯放疗组患者的1、2、3年局部控制率则分别为57.7%Objective:To observe the effeet of involved-field intensity modulated radiation therapy(IMRT)with or with-out thalidomide on the short-term efficacy,side effects and long-term outcomes in esophageal carcinoma patients over 75 years old.Methods:90 eligible esophageal carcinoma elderly patients not less than 75 years old treated with involved-field irradiation(IFI)in our hospital from January 2017 to December 2018 were retrospectively analyzed.Those patients were assigned to the IFI with thalidomide group and the FI only group.The former received thalidomide 100 mg every night before sleep throughout radiotherapy.Results:A total of 90 patients met the inclusion criteria,of which 45 patients received IFI only,and another 45 patients received thalidomide and FI.There were no significant differences between two groups in objective response rate(84.44%vs 77.77%,χ^(2)=0.653,P=0.419),disease control rate(97.77%vs 95.55%,χ^(2)=0.345,P=0.557)and the ineidence of leukopenia(26.67%vs 22.22%,χ^(2)=0.241,P=0.624).The ineidence of radiation esophagitis in the FI with thalidomide group was significantly lower than that in the FI only group(28.89%vs 55.56%,χ^(2)=6.559,P=0.010).The mean day in which radiation esophagitis occurred(day 16.23±3.13)in the FI with thalidomide group was significantly later than that in the IFI only group(day 10.30±2.09)(t=5.070,P<0.001);and the IL-6 level in radiation esophagitis patients[(13.86±7.10)pg/ml]in the former was significantly lower than that in the latter[(28.84±12.34)pg/ml](t=4.218,P=0.001).There was no significant difference in the ineidence of radiation pneumonitis between two groups(17.78%vs 22.22%,χ^(2)=0.278,P=0.598).The difference was not significant(χ^(2)=2.127,P=0.145)in 1-,2-and 3-year survival rates between the IFI with thalidomide group(77.8%,44.4%and 26.7%)and the IFI only group(73.3%,37.7% and 22.2%),while it was(χ^(2)=3.859,P=0.049)in 1-,2- and 3-year local control rates(75.6%vs 57.7%,40.0%vs 31.1%,and 22.2%vs 11.1%).Conclusion:Involved-field IMRT combined with thal

关 键 词：食管癌 沙利度胺 放射治疗 高龄患者 

分 类 号：R193[医药卫生—卫生事业管理] R195[医药卫生—公共卫生与预防医学]