调强放疗联合小剂量阿帕替尼治疗老年食管癌的疗效观察

doi:10.3969/j.issn.1003-9198.2022.02.010

摘要/Abstract

摘要： 目的比较阿帕替尼联合调强放疗和单纯调强放疗治疗老年食管癌的疗效和不良反应。方法回顾性分析收住我院的60例老年食管鳞癌初治病人,根据治疗方法分为单纯放疗组、阿帕替尼联合放疗组,每组30例。2组均采用调强放疗技术,联合治疗组在放疗过程中及后续给予阿帕替尼片250 mg/d治疗。结果所有病人均按计划完成放疗,联合组与单纯放疗组的总缓解率分别为76.67%(23/30)和70.00%(21/30),差异无统计学意义(P>0.05)。联合组肿瘤缓解深度≥50%的比例为73.34%(22/30),高于单纯放疗组的46.67%(14/30),差异有统计学意义(P=0.035)。联合组中位无进展生存时间(PFS)为16.0个月,单纯放疗组为11.0个月,差异有统计学意义(P=0.042)。2组2年生存率分别为49.00%、40.00%,差异无统计学意义(P=0.064);2组放射性食管炎发生率差异无统计学意义(P>0.05)。联合组主要的不良反应有:蛋白尿(23.33%)、高血压(20.00%)、手足综合征(10.00%),均为Ⅰ~Ⅱ级不良反应。结论小剂量阿帕替尼联合调强放疗治疗可以提高肿瘤缓解深度,延长PFS,不增加放射性食管炎发生率,不良反应可以耐受。

关键词: 老年人, 食管癌, 阿帕替尼, 调强放疗

Abstract: Objective To compare the efficacy and adverse effects of intensity modulated radiotherapy combined with apatinib and intensity modulated radiotherapy alone in the elderly patients with esophageal cancer. Methods A total of 60 elderly patients with esophageal cancer were retrospectively collected and divided into the radiotherapy group and the radiotherapy combined with apatinib group (combination group). Both groups received intensity modulated radiotherapy, and the combination group received apatinib tablets 250 mg/d in addition during and after radiotherapy. Results All the patients completed radiotherapy as planned, and the overall efficacy rate of the combined group and the radiotherapy group was 76.67%(23/30) and 70.00%(21/30), respectively, with no significant difference(P>0.05). The proportion of cases with depth of response≥50% in the combination group was 73.34%(22/30), compared with 46.67%(14/30) in the radiotherapy group(P=0.035). The median progression-free survival time(PFS) in the combination group was 16 months, compared with 11 months in the radiotherapy group(P=0.042). The 2-year survival rate of the combination group and the radiotherapy group was 49.00% and 40.00% respectively, and there was no significant difference(P=0.064). The incidence rate of radiation esophagitis was not significantly different between the two groups (P>0.05); Additionally, in the combination group, 23.33%(7/30) showed proteinuria, 20.00%(6/30) showed hypertension, and 10.00% (3/30) showed hand-foot syndrome, all of which were grade I-II adverse effects. Conclusions Low-dose apatinib combined with radiotherapy can in crease the depth of tumor response and PFS, without increasing the risk of radiation esophagitis, and the other side effects can be tolerated.

Key words: aged, esophageal cancer, apatinib, intensity modulated radiotherapy

中图分类号:

R 735.1

王玉芳, 刘美荣, 李明君. 调强放疗联合小剂量阿帕替尼治疗老年食管癌的疗效观察[J]. 实用老年医学, 2022, 36(2): 146-149.

WANG Yu-fang, LIU Mei-rong, LI Ming-jun. Curative effect of intensity modulated radiotherapy combined with low-dose apatinib in the treatment of elderly patients with esohageal cancer[J]. Practical Geriatrics, 2022, 36(2): 146-149.

参考文献

[1] WONG M, HAMILTON W, WHITEMAN D C, et al. Global incidence and mortality of oesophageal cancer and their correlation with socioeconomic indicators temporal patterns and trends in 41 countries[J]. Sci Rep, 2018, 8(1):4522.
[2] HUANG S, ZHENG S, GONG T, et al. Survival benefit evaluation of radiotherapy in esophageal cancer patients aged 80 and older[J]. Oncotarget, 2017, 8(67):112094-112102.
[3] CHEN W, ZHENG R, BAADE P D, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin,2016, 66(2):115-132.
[4] LIU Y, GUO L, YANG C, et al. Clinical evidence on apatinib in treating chemotherapy-refractory metastatic esophageal squamous cell carcinoma[J]. Clin Oncol Res, 2020, 3(3):1-7.
[5] YANWEI L, FENG H, REN P, et al. Safety and efficacy of apatinib monotherapy for unresectable, metastatic esophageal cancer: a single-arm, open-label, phase Ⅱ study[J]. Oncologist, 2020,(25):e1464-e1472.
[6] MILLER A B, HOOGSTRATEN B, STAQUET M, et al. Reporting results of cancer treatment[J].Cancer, 1981, 47(1):207-214.
[7] COX J D, JOANN S B S, PAJAK T F. Toxicity criteria of the Radiation Therapy Oncology Group(RTOG) and the European Organization for Research and Treatment of Cancer(EORTC)[J]. Int J Radiat Oncol Biol Phys, 1995, 31(5):1341-1346.
[8] CHERRYBOHANNAN J, BAKER K, FRANCIS H. VEGF and cholangiocarcinoma: feeding the tumor[J]. Translat Astrointest Cancer, 2012, 1(1):95-102.
[9] NCCN Guidelines. Esophageal and Esophagogastric Junction Cancers[M].Version 4. Bethesda: NCCN Guide-lines, 2020.
[10] 中国临床肿瘤学会指南工作委员会. 中国临床肿瘤学会(CSCO)食管癌诊疗指南2020[M]. 北京:人民卫生出版社, 2020.
[11] 孙菲, 孙志强, 汪建林, 等. 阿帕替尼对食管癌Kyse-150细胞放射敏感性影响的实验研究[J]. 中华放射医学与防护杂志, 2017, 37(11): 805-809, 831.
[12] 肖宏卫, 许晓峰, 鲍玲丽, 等. 阿帕替尼+卡培他滨小剂量联合放疗治疗老年食管癌的临床疗效分析[J]. 中国实用医药, 2020, 15(26):128-130.
[13] MCCOACH C E, BLUMENTHAL G M, ZHANG L, et al. Exploratory analysis of the association of depth of response and survival in patients with metastatic non-small-cell lung cancer treated with a targeted therapy or immunotherapy[J]. Ann Oncol, 2017, 28(11):2707-2714.
[14] SIENA S, HERRERO F R, DOUILLARD J Y, et al. Impact of depth of response(DpR) on survival in patients(pts) with RAS wild-type(WT) metastatic colorectal cancer(mCRC) receiving first-line panitumumab + FOLFOX4 vs FOLFOX4[J]. Ann Oncol, 2016, 27(suppl 6): vi149-vi206.
[15] 徐龙, 张冠中, 谢晓冬, 等. 广泛期小细胞肺癌一线化疗肿瘤缓解深度与生存期的相关性[J]. 现代肿瘤医学, 2019, 27(4):591-594.