双靶区交替调强放疗联合康莱特注射液治疗晚期弥漫型肝癌的临床研究
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摘要
目的探讨双靶区交替调强放疗联合康莱特注射液治疗晚期弥漫型肝癌的疗效。方法将符合研究要求的58例弥漫型肝癌患者随机分为2组,观察组29例患者选择双靶区交替调强适形放疗(30 Gy/15次)联合康莱特注射液治疗,对照组29例患者仅行双靶区交替调强适形放疗(30 Gy/15次),观察2组患者治疗3个月后KPS评分改善情况、细胞免疫功能变化,统计2组患者近期临床疗效、不良反应发生情况,并随访2组患者生存情况。结果观察组患者治疗后KPS评分上升大于10分比例(92.86%)明显高于对照组(70.37%)(P<0.05)。2组患者治疗后CD3~+、CD4~+、CD4~+/CD8~+均明显升高(P均<0.05),且观察组均明显高于对照组(P均<0.05);观察组患者治疗后CD8~+明显降低(P<0.05),对照组患者无明显变化(P>0.05),2组患者治疗后CD8~+比较差异无统计学意义(P均>0.05)。2组患者疾病控制率、治疗后中位生存期及3个月、6个月累积生存率比较差异均无统计学意义(P均>0.05),但观察组1年累积生存率明显高于对照组(P<0.05)。2组患者Ⅲ～Ⅳ级放射性肝炎发生率比较差异无统计学意义(P>0.05),但观察组乏力、Ⅰ～Ⅱ级消化道反应、Ⅰ～Ⅱ度骨髓抑制发生率均明显低于对照组(P均<0.05)。结论双靶区交替调强放疗联合康莱特注射液治疗晚期弥漫型肝癌可提高患者生活质量和免疫力,延长生存期,降低Ⅰ～Ⅱ级消化道反应和Ⅰ～Ⅱ度骨髓抑制的发生率,在临床上值得推广应用。
Objective It is to observe the curative effect of dual-target alternating and intensity modulated radiation therapy combined with Kanglaite on advanced diffused hepatocellular carcinoma.Methods 58 cases of advanced diffused hepatocellular carcinoma patients who met the research requirements were randomly divided into 2 groups:observation group(n=29)and control group(n=29).The observation group was treated by dual-target alternating radiotherapy(IM-RT,intensity modulated radiotherapy,30 Gy/15 times)and Kanglaite injection.The control group was treated by dual-target alternating radiotherapy(30 Gy/15 times)only.The improvement of KPS score and the change of cellular immune function were observed after 3 months of treatment.The short-term clinical efficacy and adverse reactions of the two groups were compared,and the survival rate of the two groups was followed up.Results The proportion of KPS score increased by morethan 10 points(92.86%)after treatment in the observation group was significantly higher than that of the control group(70.37%)(P<0.05).After treatment,CD3~+,CD4~+,CD4~+/CD8~+were significantly increased in both groups(P<0.05),and these indexes in the observation group were significantly higher than those in the control group(P<0.05).CD8~+was significantly decreased after treatment in the observation group(P<0.05),while there was no significant change in the control group(P>0.05),there was no significant difference in CD8~+between the two groups after treatment(P>0.05).There was no significant difference in disease control rate,median survival after treatment,and cumulative survival rate of 3 months and 6 months between the two groups(P>0.05),but the 1-year cumulative survival rate of the observation group was significantly higher than that of the control group(P<0.05).There was no significant difference in the incidence of gradeⅢ-Ⅳradiation hepatitis between the two groups(P>0.05),but the incidence of fatigue,Ⅰ-Ⅱgastrointestinal reaction andⅠ-Ⅱdegree myelosuppression were significantly lower in the observation group than those in the control group(P<0.05).Conclusion Dual-target alternating and intensity modulated radiation therapy combined with Kanglaite can improve the quality of life,enhance immune function,prolong the survival time,reduce the incidence ofⅠ-Ⅱgrade digestive tract reaction and bone marrow suppression in the patients with advanced diffused hepatocellular carcinoma,it is worth of popularization and application in clinic.
Objective It is to observe the curative effect of dual-target alternating and intensity modulated radiation therapy combined with Kanglaite on advanced diffused hepatocellular carcinoma.Methods 58 cases of advanced diffused hepatocellular carcinoma patients who met the research requirements were randomly divided into 2 groups:observation group(n=29)and control group(n=29).The observation group was treated by dual-target alternating radiotherapy(IM-RT,intensity modulated radiotherapy,30 Gy/15 times)and Kanglaite injection.The control group was treated by dual-target alternating radiotherapy(30 Gy/15 times)only.The improvement of KPS score and the change of cellular immune function were observed after 3 months of treatment.The short-term clinical efficacy and adverse reactions of the two groups were compared,and the survival rate of the two groups was followed up.Results The proportion of KPS score increased by morethan 10 points(92.86%)after treatment in the observation group was significantly higher than that of the control group(70.37%)(P<0.05).After treatment,CD3~+,CD4~+,CD4~+/CD8~+were significantly increased in both groups(P<0.05),and these indexes in the observation group were significantly higher than those in the control group(P<0.05).CD8~+was significantly decreased after treatment in the observation group(P<0.05),while there was no significant change in the control group(P>0.05),there was no significant difference in CD8~+between the two groups after treatment(P>0.05).There was no significant difference in disease control rate,median survival after treatment,and cumulative survival rate of 3 months and 6 months between the two groups(P>0.05),but the 1-year cumulative survival rate of the observation group was significantly higher than that of the control group(P<0.05).There was no significant difference in the incidence of gradeⅢ-Ⅳradiation hepatitis between the two groups(P>0.05),but the incidence of fatigue,Ⅰ-Ⅱgastrointestinal reaction andⅠ-Ⅱdegree myelosuppression were significantly lower in the observation group than those in the control group(P<0.05).Conclusion Dual-target alternating and intensity modulated radiation therapy combined with Kanglaite can improve the quality of life,enhance immune function,prolong the survival time,reduce the incidence ofⅠ-Ⅱgrade digestive tract reaction and bone marrow suppression in the patients with advanced diffused hepatocellular carcinoma,it is worth of popularization and application in clinic.
引文
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[8]张江洲,王斌,龙志雄,等.双靶区序贯调强放疗联合介入治疗巨块型肝癌的临床研究[J].中国普通外科杂志,2016,25(1):32-38
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[10]杨帆,袁昌劲.康莱特注射液(KLT)对hepg2细胞诱导产生的大鼠原发性肝癌的作用研究[J].湖北中医杂志,2016,38(1):22-24
[11]李敏,王媛,惠双.康莱特注射液治疗中晚期原发性肝癌47例疗效观察[J].中药药理与临床,2015,31(6):197-199
[2]Yin H,Lu K,Qiao WB,et al.Whole-liver radiotherapy concurrent with chemotherapy as a palliative treatment for colorectal patients with massive and multiple liver metastases:a retrospective study[J].Asian Pac J Cancer Prev,2014,15(4):1597-1602
[3]Edyta WR,Jakub L,Jerzy W.Whole Liver Palliative Radiotherapy for Patients with Massive Liver Metastases[J].Asian Pac J Cancer Prev,2015,16(15):63
[4]叶云飞,杨倞,孙永健,等.巨块型肝癌的放射治疗临床效果探讨[J].现代生物医学进展,2013,13(25):4947-4949
[5]Long ZX,Wang B,Tao D,et al.Clinical research on alternating hyperfraction radiotherapy for massive hepatocellular carcinoma[J].Oncol Lett,2015,10(1):523-527
[6]Yamashita H,Onishi H,Matsumoto Y,et al.Local effect of stereotactic body radiotherapy for primary and metastatic liver tumors in 130 Japanese patients[J].Radiat Oncol,2014,9(1):112
[7]Gavanier M,Ayav A,Sellal C,et al.CT imaging findings in patients with advanced hepatocellular carcinoma treated with sorafenib:Alternative response criteria(Choi,European Association for the Study of the Liver,and modified Response Evaluation Criteria in Solid Tumor(mRE-CIST))versus RECIST 1.1[J].Eur J Radiol,2016,85(1):103-112
[8]张江洲,王斌,龙志雄,等.双靶区序贯调强放疗联合介入治疗巨块型肝癌的临床研究[J].中国普通外科杂志,2016,25(1):32-38
[9]张江洲,龙志雄.肝癌立体定向精确放疗的临床应用进展[J].中国普外基础与临床杂志,2016,23(1):119-122
[10]杨帆,袁昌劲.康莱特注射液(KLT)对hepg2细胞诱导产生的大鼠原发性肝癌的作用研究[J].湖北中医杂志,2016,38(1):22-24
[11]李敏,王媛,惠双.康莱特注射液治疗中晚期原发性肝癌47例疗效观察[J].中药药理与临床,2015,31(6):197-199