调强适形放射治疗在中晚期食管癌中的应用效果及对患者血清肿瘤标志物的影响  

Application effect of intensity-modulated radiation therapy in patients with middle-advanced esophageal cancer and its effect on serum tumor markers

作　　者：习攀 刘慧娟 张璞 XI Pan;LIU Huijuan;ZHANG Pu(Department of Radiotherapy,Shaanxi Provincial Cancer Hospital,Xi’an 710061,Shaanxi,China;Department of Thoracic Surgery,Xi’an International Medical Center Hospital,Xi’an 710100,Shaanxi,China)

机构地区：[1]陕西省肿瘤医院放疗科,西安710061 [2]西安国际医学中心医院胸外科,西安710100

出　　处：《癌症进展》2023年第23期2580-2583,共4页Oncology Progress

基　　金：陕西省卫生健康科研基金项目(2022D046)。

摘　　要：目的 探讨调强适形放射治疗(IMRT)在中晚期食管癌中的应用效果及对患者血清肿瘤标志物的影响。方法 依据治疗方案的不同将100例中晚期食管癌患者分为常规组和观察组,每组50例,常规组患者给予常规放疗联合顺铂+5-氟尿嘧啶化疗,观察组患者给予IMRT联合顺铂+5-氟尿嘧啶化疗。比较两组患者的临床疗效、血清肿瘤标志物[癌胚抗原(CEA)、转化生长因子-β1(TGF-β1)、鳞状细胞癌相关抗原(SCC-Ag)]水平、危及器官剂量学参数及不良反应发生情况。结果 观察组患者的疾病控制率为88.00%,明显高于常规组患者的62.00%,差异有统计学意义(P﹤0.01)。治疗后,两组患者血清CEA、TGF-β1、SCC-Ag水平均低于本组治疗前,观察组患者血清CEA、TGF-β1、SCC-Ag水平均低于常规组,差异均有统计学意义(P﹤0.05)。观察组患者肺平均剂量(MLD)、接受5 Gy照射的肺体积占总肺体积的百分比(V_(5))、V_(10)、V_(20)、V_(30)以及心脏平均剂量(MHD)、接受30 Gy照射的心脏体积占总心脏体积的百分比(V_(30))、V_(40)、V_(45)、V_(50)均低于常规组,差异均有统计学意义(P﹤0.05)。观察组患者皮肤反应、肝功能异常、恶心呕吐、骨髓抑制、放射性食管炎、放射性肺炎发生率均低于常规组,差异均有统计学意义(P﹤0.05)。结论 IMRT应用于中晚期食管癌患者效果显著,可有效降低血清肿瘤标志物水平、危及器官照射剂量及不良反应发生率。Objective To investigate the efficacy of intensity-modulated radiation therapy (IMRT) in patients with middle-advanced esophageal cancer and its effect on serum tumor markers.Method A total of 100 patients with middleadvanced esophageal cancer were divided into conventional group (n=50,received conventional radiotherapy combined with cisplatin+5-fluorouracil) and observation group (n=50,received IMRT combined with cisplatin+5-fluorouracil) according to different treatment methods.The clinical efficacy,serum tumor markers[carcinoembryonic antigen (CEA),transforming growth factor-β1 (TGF-β1),squamous carcinoma-associated antigen (SCC-Ag)],dosimetric parameters of involved organs and adverse reactions were compared between the two groups.Result The disease control rate of the observation group was 88.00%,which was higher than 62.00%of the control group,and the difference was statistically significant (P<0.01).After treatment,the serum levels of CEA,TGF-β1 and SCC-Ag in two groups were lower than those before treatment,the serum levels of CEA,TGF-β1 and SCC-Ag in observation group were lower than those in conventional group,and the differences were statistically significant (P<0.05).The mean lung dose (MLD),the percentage of lung volume irradiated with 5 Gy to total lung volume (V_5),V_(10),V_(20),V_(30),and the mean heart dose (MHD),the percentage of heart volume irradiated with 30 Gy to total heart volume (V_(30)),V_(40),V_(45),V_(50)in the observation group were lower than those in the conventional group (P<0.05).The incidence of skin reaction,abnormal liver function,nausea and vomiting,myelosuppression,radiation esophagitis and radiation pneumonia in observation group were lower than those in conventional group (P<0.05).Conclusion IMRT has significant effect in patients with middle-advanced esophageal cancer,which can reduce levels of serum tumor markers,radiation dose of involved organs,and the incidence of adverse reactions.

关 键 词：食管癌 调强放射治疗 癌胚抗原 转化生长因子-Β1 鳞状细胞癌相关抗原 

分 类 号：R735.1[医药卫生—肿瘤]