适形放疗联合化疗治疗晚期膀胱癌效果观察
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摘要
目的观察适形放疗联合化疗治疗晚期膀胱癌效果观察。方法选取江西省中西医结合医院2013年2月—2015年5月收治的晚期膀胱癌76例,根据治疗方案将其分成两组,每组38例。对照组采用化疗,观察组采用放疗+化疗,分析两组疗效、卡氏行为评分(KPS)评分、复发率、生存率、尿液中相关因子水平以及不良反应情况。结果观察组总有效率高于对照组(P<0.05)。两组治疗后1个月KPS评分均较治疗前升高(P<0.05)。观察组半年内复发率低于对照组(P<0.05),1年内复发率略低于对照组,但差异无统计学意义(P>0.05);观察组在1、2年生存率均略高于对照组,但组间差异无统计学意义(P>0.05)。治疗后两组尿液中膀胱肿瘤抗原、核基质蛋白、尿膀胱癌抗原的水平均较治疗前下降(P<0.05),且观察组三者水平均较对照组低(P<0.05)。两组的III~IV级不良反应发生率相当(P>0.05)。结论对于晚期膀胱癌,化疗+放疗可提高近期疗效,改善生活质量,但对远期复发率、生存率无明显提高,放疗不会明显加重不良反应。
Objective To observe effect of conformal radiotherapy combined with chemotherapy in treatment of patients with advanced bladder cancer. Methods A total of 76 patients with advanced bladder cancer admitted during February 2013 and May 2015 were divided into observation group( n = 38) and control group( n = 38) according to different treatment methods. Control group was treated with chemotherapy,while observation group was treated with radiotherapy and chemotherapy. Therapeutic effect,Karnofsky( KPS) score,recurrence rate,survival rate,levels of related factors in urine and adverse reaction were analyzed in two groups. Results The total effective rate in observation group was significantly higher than that in control group( P < 0. 05). In 1 month after treatment,KPS scores were significantly higher than those before treatment in two groups( P < 0. 05). Within 6 months after treatment,recurrence rate in observation group was significantly lower than that in control group( P < 0. 05). Within 1 year after treatment,recurrence rate in observation group was slightly lower than that in control group,but the difference was not statistically significant( P >0. 05). Survival rates in 1 year and 2 years in observation group were slightly higher than those in control group,but the difference was not statistically significant between groups( P > 0. 05). After treatment,levels of bladder tumor antigen,nuclear matrix protein,urine bladder cancer antigen were significantly lower than before treatment in two groups( P <0. 05),and the levels in observation group were significantly lower than those in control group( P < 0. 05). Incidence rates of III-IV adverse reactions were similar in two groups,but the differences showed no statistical significances between groups( P > 0. 05). Conclusion Chemotherapy combined with radiotherapy in treatment of patients with advanced bladder cancer may improve short-term efficacy and quality of life in the near future,but it has no significant effects on longterm recurrence rate and survival rate,and radiotherapy will not obviously aggravate adverse reactions.
Objective To observe effect of conformal radiotherapy combined with chemotherapy in treatment of patients with advanced bladder cancer. Methods A total of 76 patients with advanced bladder cancer admitted during February 2013 and May 2015 were divided into observation group( n = 38) and control group( n = 38) according to different treatment methods. Control group was treated with chemotherapy,while observation group was treated with radiotherapy and chemotherapy. Therapeutic effect,Karnofsky( KPS) score,recurrence rate,survival rate,levels of related factors in urine and adverse reaction were analyzed in two groups. Results The total effective rate in observation group was significantly higher than that in control group( P < 0. 05). In 1 month after treatment,KPS scores were significantly higher than those before treatment in two groups( P < 0. 05). Within 6 months after treatment,recurrence rate in observation group was significantly lower than that in control group( P < 0. 05). Within 1 year after treatment,recurrence rate in observation group was slightly lower than that in control group,but the difference was not statistically significant( P >0. 05). Survival rates in 1 year and 2 years in observation group were slightly higher than those in control group,but the difference was not statistically significant between groups( P > 0. 05). After treatment,levels of bladder tumor antigen,nuclear matrix protein,urine bladder cancer antigen were significantly lower than before treatment in two groups( P <0. 05),and the levels in observation group were significantly lower than those in control group( P < 0. 05). Incidence rates of III-IV adverse reactions were similar in two groups,but the differences showed no statistical significances between groups( P > 0. 05). Conclusion Chemotherapy combined with radiotherapy in treatment of patients with advanced bladder cancer may improve short-term efficacy and quality of life in the near future,but it has no significant effects on longterm recurrence rate and survival rate,and radiotherapy will not obviously aggravate adverse reactions.
引文
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[10]杨华,李坚勇,谭卫,等.不同药物膀胱灌注预防膀胱肿瘤患者术后复发的临床研究[J].解放军医药杂志,2016,28(12):59-61.
[11]Kameyama K,Horie K,Mizutani K,et al.Enzalutamide inhibits proliferation of gemcitabine-resistant bladder cancer cells with increased androgen receptor expression[J].Int J Oncol,2016,14(8):124-126.
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[13]任庆,熊锐华,田秀荣,等.吉西他滨联合顺铂治疗晚期膀胱癌的临床观察[J].重庆医学,2014,43(34):4660-4661.
[14]王金万,曹虎强.三维适形放疗联合化疗治疗恶性膀胱肿瘤的疗效和安全性[J].实用临床医药杂志,2015,19(19):44-47.
[15]陈轶杰,李艾恩,李凯新,等.膀胱癌放射治疗预后的影响因素分析[J].重庆医学,2016,45(7):954-957.
[16]Ohara K,Oyama K,Suzuki A,et al.Radiotherapy intensified by increase of fraction size using three-dimensional conformal radiotherapy in bladder preservation therapy[J].Journal of Cancer Therapy,2015,06(11):993-999.
[17]何伟岳,陆启轮,卢健.三维适形放射治疗高龄膀胱癌临床分析[J].中华肿瘤防治杂志,2016,23(s1):178-179.
[18]吴洪财,匡如,盛晓.适形放疗联合GT方案化疗加吡柔比星热灌注化疗治疗老年晚期膀胱癌的临床观察[J].中国实用医刊,2016,43(7):60-61.
[2]Rose T L,Milowsky M I.Improving systemic chemotherapy for bladder cancer[J].Current Oncology Reports,2016,18(5):27.
[3]毛健伟,李庆文.肌层浸润性膀胱癌的治疗进展[J].中华全科医学,2013,11(5):778-780,831.
[4]那彦群,李宁忱,谢立平.膀胱癌临床诊断与治疗[M].北京:人民卫生出版社,2012:36-37
[5]Mor V,Laliberte L,Morris J N,et al.The Karnofsky Performance Status Scale.An examination of its reliability and validity in a research setting[J].Cancer,1984,53(9):2002-2007.
[6]魏齐铭,叶云,黄毅岚.抗肿瘤药物的应用评价[J].中国全科医学,2015,18(35):4358-4361.
[7]杨学宁,吴一龙.实体瘤治疗疗效评价标准-RECIST[J].循证医学,2004,4(2):85-90,111.
[8]Galsky M D,Stensland K D,Moshier E,et al.Effectiveness of adjuvant chemotherapy for locally advanced bladder cancer[J].J Clin Oncol.2016,34(8):825-832.
[9]魏晓龙,郭和清.晚期膀胱癌化疗进展[J].微创泌尿外科杂志,2013,2(2):146-150.
[10]杨华,李坚勇,谭卫,等.不同药物膀胱灌注预防膀胱肿瘤患者术后复发的临床研究[J].解放军医药杂志,2016,28(12):59-61.
[11]Kameyama K,Horie K,Mizutani K,et al.Enzalutamide inhibits proliferation of gemcitabine-resistant bladder cancer cells with increased androgen receptor expression[J].Int J Oncol,2016,14(8):124-126.
[12]Christodouleas J P,Hwang W T,Baumann B C,Adjuvant Radiation for Locally Advanced Bladder Cancer?A Question Worth Asking[J].Int J Radiat Oncol Biol Phys,2016,94(5):1040-1042
[13]任庆,熊锐华,田秀荣,等.吉西他滨联合顺铂治疗晚期膀胱癌的临床观察[J].重庆医学,2014,43(34):4660-4661.
[14]王金万,曹虎强.三维适形放疗联合化疗治疗恶性膀胱肿瘤的疗效和安全性[J].实用临床医药杂志,2015,19(19):44-47.
[15]陈轶杰,李艾恩,李凯新,等.膀胱癌放射治疗预后的影响因素分析[J].重庆医学,2016,45(7):954-957.
[16]Ohara K,Oyama K,Suzuki A,et al.Radiotherapy intensified by increase of fraction size using three-dimensional conformal radiotherapy in bladder preservation therapy[J].Journal of Cancer Therapy,2015,06(11):993-999.
[17]何伟岳,陆启轮,卢健.三维适形放射治疗高龄膀胱癌临床分析[J].中华肿瘤防治杂志,2016,23(s1):178-179.
[18]吴洪财,匡如,盛晓.适形放疗联合GT方案化疗加吡柔比星热灌注化疗治疗老年晚期膀胱癌的临床观察[J].中国实用医刊,2016,43(7):60-61.