同步放化疗联合重组人血管内皮抑制素治疗中晚期宫颈癌的近期疗效

发布时间：2018-05-04 22:30

本文选题：宫颈癌 + 重组人血管内皮抑制素　；参考：《大连医科大学》2014年硕士论文

【摘要】：背景与目的：宫颈癌为女性最常见的生殖系统肿瘤，居女性死亡原因的第三位,每年全世界约有接近274,000的妇女死于该疾病，严重威胁着妇女健康。由于宫颈癌起病隐匿，确诊时多已进展为中晚期疾病。放射治疗为中晚期宫颈癌的主要治疗手段。尽管随着医学影像技术和放疗技术方面的发展，明显提高了肿瘤靶区适形度和剂量，同时周围正常组织和器官受照剂量及体积较前有降低。但中晚期宫颈癌的总生存率仍在50%左右，较前并无显著提高。单纯放疗不能阻断肿瘤细胞的扩散与转移，肿瘤局部未控、复发、淋巴结转移及远处转移是治疗失败的主要原因。对局部肿瘤、全身转移及潜在转移灶进行综合治疗是目前宫颈癌的主要研究方向之一。近年来，多个随机临床研究结果显示，与单纯放疗相比，以顺铂为基础的同步放化疗能明显改善中晚期宫颈癌患者的生存率。但是同步放化疗的治疗方法不能有效解决肿瘤的扩散与转移问题，所以近年来对于中晚期宫颈癌采用放化疗的基础上加用阻断血管生成的药物成为研究的热点。重组人血管内皮抑制素是我国自主研发的血管内皮抑制素药物。该药能够使血管内皮细胞的增殖和迁移受到明显且特异性地抑制，从而使为肿瘤的生长和转移提供营养物质的新生血管的形成收到抑制。同时，有研究表明恩度还可以抑制淋巴结的转移及淋巴管的新生。目前恩度联合化学治疗已作为一线方案用于转移性结直肠癌、胃癌及进展期非小细胞肺癌的治疗，显示出良好的治疗效果及耐受性。本文回顾性分析了我院收治的56例中晚期宫颈癌患者，比较分析了恩度联合同步放化疗与同步放化疗的近期疗效及急性毒副反应。方法：对56例2011年1月-2013年12月在大连医科大学附属第二医院肿瘤放疗科首次接受治疗的中晚期宫颈癌患者的临床资料进行了回顾性分析。将其分为同步放化治疗组（以下称对照组）和同步放化联合恩度组（以下简称恩度组）。对照组29例，年龄30-74岁，中位年龄52岁。恩度组27例，年龄34-75岁，中位年龄53岁。一般资料比较两组患者的差异无统计学意义（P0.05）。对照组采用盆腔三维适形放疗、腔内后装治疗同步单药顺铂化疗。恩度组除给予上述治疗外，还联合恩度进行治疗。近期疗效的评价在患者治疗结束后3个月，，根据患者的临床检查结果及盆腔MRI/CT检查结果进行评价。评价标准依据实体瘤治疗疗效评价标准RECIST进行判断。在治疗过程中及治疗结束后3个月内记录患者的骨髓抑制、直肠反应、胃肠道反应及泌尿生殖道反应等早期并发症的发病情况，不良反应的分级依据RTOG急性放射损伤分级标准进行评价。结果：治疗结束后3个月，对照组完全缓解16例（55.17%），部分缓解9例（31.03%），病变稳定2例（6.90%），有效率（CR+PR）86.21%。恩度组完全缓解17例（62.96%），部分缓解8例（29.63%），病变稳定1例（3.70%），有效率（CR+PR）92.59%。恩度组的完全缓解率（CR%）高于对照组，但差异没有统计学意义（2=0.351，P＞0.05）。恩度组的有效率[（CR+PR）%]高于对照组，差异也没有统计学意义（2=0.596，P＞0.05）。急性不良反应方面，恩度组与对照组中骨髓抑制发生率分别为59.26%（16/27）和62.07%（18/29）、直肠反应发生率分别为25.93%（7/27）和31.03%（9/29），差异均无统计学意义（P＞0.05）。两组胃肠道反应分别为66.66%（18/27）和62.07%（18/29）、泌尿生殖道反应发生率分别是18.52%（5/27）和20.69%（6/29），差异均无统计学意义（P＞0.05）。结论：本研究表明，同步放化疗联合重组人血管内皮抑制素用于中晚期宫颈癌患者，其治疗有效率较同步放化疗有所提高，且不良反应没有增加。因此此种联合治疗方法有希望成为有效治疗中晚期宫颈癌的新模式。
[Abstract]:Background and purpose: cervical cancer is the most common reproductive system tumor in women. It is the third cause of female death. Nearly 274000 of the women worldwide die of the disease every year. It is a serious threat to the health of women. Although with the development of medical imaging technology and radiotherapy technology, the conformability and dose of tumor target area have been improved obviously, while the dose and volume of normal tissues and organs in the surrounding tissues and organs are lower than before. However, the total survival rate of middle and late cervical cancer is still around 50%, and no significant improvement has been made. Proliferation and metastasis of cells, local uncontrolled tumor, recurrence, lymph node metastasis and distant metastasis are the main causes of treatment failure. Comprehensive treatment of local tumors, whole body metastases and potential metastases is one of the main research directions for cervical cancer. In recent years, multiple randomized clinical studies have shown that compared with simple radiotherapy, the results show that Platinum based concurrent chemoradiotherapy can significantly improve the survival rate of patients with advanced and advanced cervical cancer. However, the treatment of concurrent chemoradiotherapy can not effectively solve the problem of tumor diffusion and metastasis. Therefore, in recent years, the use of chemotherapy and chemotherapy on the basis of chemotherapy and chemotherapy has become a hot topic in the study. Endostatin (endostatin) is a self-developed endostatin in our country. The drug can inhibit the proliferation and migration of vascular endothelial cells obviously and specifically, so that the formation of new blood vessels that provide nutrients for the growth and metastasis of the tumor is suppressed. Present grace combined chemical therapy has been used as a first-line scheme for the treatment of metastatic colorectal cancer, gastric cancer and advanced non small cell lung cancer, showing good therapeutic effect and tolerance. This paper reviewed 56 cases of middle and advanced cervical cancer patients in our hospital and analyzed the combination of degree of grace. The short-term efficacy and acute toxicity of concurrent chemoradiotherapy and concurrent chemoradiotherapy.
Methods: the clinical data of 56 patients with advanced cervical cancer, which were first treated in the Radiotherapy Department of the second hospital affiliated to Dalian Medical University, January 2011 -2013, were analyzed. The clinical data were divided into synchronous radiotherapy group (the lower control group) and the synchrotron synchrotron group (hereinafter referred to as the endo group). The control group was 29. For example, the age of 30-74 years, the median age of 52 years, 27 cases of grace group, age 34-75, middle age 53 years. General data compared to the two groups of patients with no statistically significant difference (P0.05). The control group was treated with pelvic three-dimensional conformal radiotherapy, intracavitary post loading treatment with single drug cisplatin chemotherapy. The evaluation of the outcome was evaluated at 3 months after the end of the patient's treatment, according to the results of the patient's clinical examination and the results of the pelvic MRI/CT examination. The evaluation criteria were based on the standard RECIST for the treatment of solid tumors. During the treatment and in the 3 months after the treatment, the patient's myelosuppression, the rectal reaction, the gastrointestinal reaction and the treatment were recorded. The incidence of early complications such as genitourinary tract reaction and grading of adverse reactions were evaluated according to RTOG acute radiation injury classification standard.
Results: 3 months after the end of the treatment, 16 cases (55.17%) were completely remission in the control group, 9 cases (31.03%), 2 cases (6.90%), 17 cases (62.96%), 8 cases (29.63%) and 55.17% cases (3.70%), and the complete remission rate (CR%) of the effective (CR+PR) 92.59%. group (CR%) was higher than that of the control group, but the rate of complete remission (CR%) was higher than the control group, but the rate of the total remission rate of the effective (CR+PR) 92.59%. group was higher than the control group. The difference was not statistically significant (2=0.351, P > 0.05). The efficiency of the degree group [(CR+PR)%] was higher than that of the control group (2=0.596, P > 0.05). The incidence of myelosuppression in the group and the control group was 59.26% (16/27) and 62.07% (18/29), respectively, and the incidence of rectal reaction was 25.93% (7/27) and 31., respectively. The difference of 03% (9/29) was not statistically significant (P > 0.05). The gastrointestinal reactions in the two groups were 66.66% (18/27) and 62.07% (18/29) respectively. The incidence of genitourinary reaction was 18.52% (5/27) and 20.69% (6/29) respectively, and the difference was not statistically significant (P > 0.05).
Conclusion: This study shows that the combination of concurrent chemoradiotherapy and recombinant human vascular endostatin for patients with middle and advanced cervical cancer is more effective than synchronous radiotherapy and chemotherapy, and the adverse reaction does not increase. Therefore, this combined therapy is hopeful to be a new model for effective treatment of middle and late cervical cancer.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33

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