纳米刀联合吉西他滨与吉西他滨同步放化疗治疗局部晚期胰腺癌对比评价
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摘要
目的采用纳米刀联合吉西他滨对局部晚期胰腺癌(LAPC)进行治疗,与吉西他滨同步放化疗作对比,分析其临床疗效及安全性。方法 LAPC患者随机分成两组,研究组采用局部纳米刀消融联合吉西他滨化疗;对照组采用吉西他滨同步放化疗。结果 (1)两组患者在治疗后12个月内多次复查CA19-9,皆呈整体下降趋势,差异均有统计学意义(P <0.05);(2)研究组肿瘤疾病控制率(DCR)为86.2%;对照组为77.8%,两组DCR比较,差异有统计学意义(P <0.05);(3)治疗1个月后,观察组KPS评分高于对照组,VAS评分和QOL-C30评分低于对照组,差异均有统计学意义(P <0.05);(4)研究组1、2年OS与对照组比较,差异均有统计学意义(P <0.05);(5)治疗后两组患者血清淀粉酶比较,差异有统计学意义(P <0.05);(6)治疗后两组患者骨髓毒性和胃肠道反应比较,差异无统计学意义(P> 0.05)。结论纳米刀消融术联合吉西他滨治疗LAPC安全性高,疗效显著,有一定的临床应用价值。
Objective To compare the efficacy difference between the local ablation of pancreatic cancer with nano-knife,combined with gemcitabine chemotherapy,and gemcitabine concurrent chemoradiotherapy,and to evaluate their clinical efficacy and safety. Methods Patients with locally advanced pancreatic cancer were randomly divided into two groups. The study group underwent local nano-knife ablation. Six cycles of gemcitabine(21 days for one cycle)chemotherapy were performed. The control group received conformal intensity-modulated radiotherapy combined with gemcitabine concurrent chemoradiotherapy. Results(1)All patients in the preoperative study group and the observation group were more than 4 times higher than the normal value of CA19-9. The patients inthetwogroupsweretreatedforthefirst,third,seventh,andtenthdays,onemonth,twomonths,andthree.Months,6 months,9 months,and 12 months of repeated review of CA19-9,all showed an overall downward trend. There were significant differences in tumor markers between the two groups at different time points(P < 0.05).(2)The tumor control rate(DCR)of the study group was 86.2%;the DCR of the control group was 77.8%. The difference was statistically significant(P < 0.05).(3)The KPS score of the observation group was significantly higher than that of the control group at 1 month of treatment,while the VAS score and QOL-C30 score were significantly lower than the control group(P < 0.05);(4)Study group 1 year,2 years OS were 54.3%,37.1%;control group OS were 36.5%,18.7%;compared two groups of patients in 1 and 2 years OS,the difference was statistically significant(P < 0.05);(5)There were 7 cases of serum amylase in the postoperative study group,and 1 case showed pancreatitis. There was no pancreatitis in the control group,but there were 3 cases of mild increase in amylase. There were significant differences in serum amylase between the two groups(P < 0.05).(6)There was no significant difference in postoperative bone marrow toxicity and gastrointestinal reactions between the two groups(P > 0.05). Conclusions Nano-knife ablation combined with gemcitabine is a safe and effective method for the treatment of locally advanced unresectable pancreatic cancer. It has certain clinical application value.
Objective To compare the efficacy difference between the local ablation of pancreatic cancer with nano-knife,combined with gemcitabine chemotherapy,and gemcitabine concurrent chemoradiotherapy,and to evaluate their clinical efficacy and safety. Methods Patients with locally advanced pancreatic cancer were randomly divided into two groups. The study group underwent local nano-knife ablation. Six cycles of gemcitabine(21 days for one cycle)chemotherapy were performed. The control group received conformal intensity-modulated radiotherapy combined with gemcitabine concurrent chemoradiotherapy. Results(1)All patients in the preoperative study group and the observation group were more than 4 times higher than the normal value of CA19-9. The patients inthetwogroupsweretreatedforthefirst,third,seventh,andtenthdays,onemonth,twomonths,andthree.Months,6 months,9 months,and 12 months of repeated review of CA19-9,all showed an overall downward trend. There were significant differences in tumor markers between the two groups at different time points(P < 0.05).(2)The tumor control rate(DCR)of the study group was 86.2%;the DCR of the control group was 77.8%. The difference was statistically significant(P < 0.05).(3)The KPS score of the observation group was significantly higher than that of the control group at 1 month of treatment,while the VAS score and QOL-C30 score were significantly lower than the control group(P < 0.05);(4)Study group 1 year,2 years OS were 54.3%,37.1%;control group OS were 36.5%,18.7%;compared two groups of patients in 1 and 2 years OS,the difference was statistically significant(P < 0.05);(5)There were 7 cases of serum amylase in the postoperative study group,and 1 case showed pancreatitis. There was no pancreatitis in the control group,but there were 3 cases of mild increase in amylase. There were significant differences in serum amylase between the two groups(P < 0.05).(6)There was no significant difference in postoperative bone marrow toxicity and gastrointestinal reactions between the two groups(P > 0.05). Conclusions Nano-knife ablation combined with gemcitabine is a safe and effective method for the treatment of locally advanced unresectable pancreatic cancer. It has certain clinical application value.
引文
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[5] New response evaluation criteria in solid tumours:revised recist guideline(version 1.1)[J]. Eur J Cancer,2009,45(2):228-247.
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[7] SIEGEL R L,MILLER K D,JEMAL A. Cancer statistics,2017[J]. CA Cancer J Clin,2017,67(1):7-30.
[8]中国癌症研究基金会介入医学委员会.晚期胰腺癌介入治疗临床操作指南(试行)[J].临床肝胆病杂志,2017,33(2):221-232.
[9] SPADI R,BRUSA F,PONZETTI A,et al. Current therapeutic strategies for advanced pancreatic cancer:A review for clinicians[J]. World J Clin Oncol,2016,7(1):27-43.
[10] MANSSON C,BRAHMSTAEDT R,NILSSON A,et al. Percutaneous irreversible electroporation for treatment of locally advanced pancreatic cancer following chemotherapy or radiochemotherapy[J]. Eur J Surg Oncol,2016,42(9):1401-1406.
[11] YAN L,CHEN Y L,SU M,et al. A single-institution experience with open irreversibleelectroporation for locally advanced pancreatic carcinoma[J]. Chin Med J(Engl),2016,129(24):2920-2925.
[12] PAIELLA S,BUTTURINI G,FRIGERIO I,et al. Safety and feasibility of irreversible electroporation(IRE)in patients with locally advanced pancreatic cancer:Results of a prospective study[J]. Dig Surg,2015,32(2):90-97.
[13] ZAGER Y,KAIN D,LANDA N,et al. Optimization of irreversible electroporation protocols for in-vivo myocardial decellularization[J]. PLoSOne,2016,11(11):e0165475.
[15] MARTION R C,MCRARLAND K,ELLIS S,et al. Irreversible electroporation therapy in the management of locally advanced pancreatic adenocarcinoma[J]. J Am Coll Surg,2012,215:361-369.
[2]张学飞,李述刚,闫贻忠,等. 2006-2010年中国肿瘤登记地区恶性肿瘤疾病负中华肿瘤防治杂志,2015,10(3):103-106.
[3] ZHANG X,TIAN J L,ZHAO L,et al. CT-guide conformal cryoablation forperipheral cry for peripheral NSCLC:Initial experience[J]. Eur J Radiol,2012,81(11):3354-3362.
[4] GOVINDARAJAN,NARAYANAN M D. Irreversible electroporation in pancreatic carcinoma[J]. Semin-ars in Interventional,2015,32(3):349-355.
[5] New response evaluation criteria in solid tumours:revised recist guideline(version 1.1)[J]. Eur J Cancer,2009,45(2):228-247.
[6] CLAVIEN P A,BARKUN J,DE OLIVEIRA M L,et al. The Clavien-Dindo classification of surgical complications:five-year expericenc[J]. Ann Surg,2009,250(2):187-196
[7] SIEGEL R L,MILLER K D,JEMAL A. Cancer statistics,2017[J]. CA Cancer J Clin,2017,67(1):7-30.
[8]中国癌症研究基金会介入医学委员会.晚期胰腺癌介入治疗临床操作指南(试行)[J].临床肝胆病杂志,2017,33(2):221-232.
[9] SPADI R,BRUSA F,PONZETTI A,et al. Current therapeutic strategies for advanced pancreatic cancer:A review for clinicians[J]. World J Clin Oncol,2016,7(1):27-43.
[10] MANSSON C,BRAHMSTAEDT R,NILSSON A,et al. Percutaneous irreversible electroporation for treatment of locally advanced pancreatic cancer following chemotherapy or radiochemotherapy[J]. Eur J Surg Oncol,2016,42(9):1401-1406.
[11] YAN L,CHEN Y L,SU M,et al. A single-institution experience with open irreversibleelectroporation for locally advanced pancreatic carcinoma[J]. Chin Med J(Engl),2016,129(24):2920-2925.
[12] PAIELLA S,BUTTURINI G,FRIGERIO I,et al. Safety and feasibility of irreversible electroporation(IRE)in patients with locally advanced pancreatic cancer:Results of a prospective study[J]. Dig Surg,2015,32(2):90-97.
[13] ZAGER Y,KAIN D,LANDA N,et al. Optimization of irreversible electroporation protocols for in-vivo myocardial decellularization[J]. PLoSOne,2016,11(11):e0165475.
[15] MARTION R C,MCRARLAND K,ELLIS S,et al. Irreversible electroporation therapy in the management of locally advanced pancreatic adenocarcinoma[J]. J Am Coll Surg,2012,215:361-369.