3DCRT联合沙利度胺、GEMOX方案化疗对晚期肝内胆管细胞癌的疗效分析

doi:10.3760/cma.j.issn.1673422X.2019.05.002

摘要/Abstract

摘要： 目的探讨三维适形放疗（3DCRT）联合沙利度胺、GEMOX方案（吉西他滨+奥沙利铂）化疗对晚期肝内胆管细胞癌患者的疗效及不良反应。方法将2015年3月至2018年6月解放军联勤保障部队第九〇一医院收治的100例晚期肝内胆管细胞癌患者以随机数字表法分为化疗组（n=50）和联合组（n=50）。化疗组给予沙利度胺、GEMOX方案化疗，联合组在化疗组治疗方案的基础上给予3DCRT。对比两组患者治疗前后血清肿瘤标志物水平、临床疗效、不良反应发生情况。结果治疗后联合组患者血清癌胚抗原（CEA）、糖类抗原125（CA125）、糖类抗原199（CA199）水平分别为（8.76±2.69）μg/L、（76.17±10.12）×103 U/L、（169.85±78.97）×103 U/L，均明显低于化疗组的（12.46±3.47）μg/L、（104.56±14.38）×103 U/L和（312.45±71.36）×103 U/L，差异均有统计学意义（t=5.959，P＜0.001；t=11.416，P＜0.001；t=9.474，P＜0.001）。联合组临床获益率、总有效率分别为64.0%（32/50）、88.0%（44/50），均分别高于化疗组的42.0%（21/50）、72.0%（36/50），差异均有统计学意义（χ2=4.857，P=0.028；χ2=4.000，P=0.046）。联合组患者白细胞减少、恶心呕吐、便秘和脱发发生率分别为20.0%（10/50）、24.0%（12/50）、30.0%（15/50）、12.0%（6/50），化疗组分别为14.0%（7/50）、16.0%（8/50）、24.0%（12/50）、8.0%（4/50），差异均无统计学意义（χ2=0.638，P=0.424；χ2=1.000，P=0.317；χ2=0.457，P=0.499；χ2=0.444，P=0.505）。结论对晚期肝内胆管细胞癌患者给予3DCRT联合沙利度胺、GEMOX方案化疗能显著降低血清肿瘤标志物水平，增强近期疗效，且不会显著增多和加重不良反应。

关键词: 胆管肿瘤, 抗肿瘤联合化疗方案, 三维适形放疗技术, 沙利度胺

Abstract: Objective To investigate the efficacy and adverse reaction of threedimensional conformal radiotherapy (3DCRT) combined with thalidomide and GEMOX regimen (gemcitabine + oxaliplatin) in patients with advanced intrahepatic cholangiocarcinoma. MethodsA total of 100 patients with advanced intrahepatic cholangiocarcinoma in 901 Hospital of Joint Logistics Support Force of Chinese People′s Liberation Army from March 2015 to June 2018 were divided into chemotherapy group (n=50) and combination group (n=50) by random number table method. The chemotherapy group was treated with thalidomide and GEMOX regimen, and the combined group was treated with 3DCRT on the basis of the chemotherapy regimen. The levels of serum tumor markers, clinical efficacy and adverse reactions of patients in the two groups were compared before and after treatment. ResultsThe levels of serum carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125) and carbohydrate antigen 19-9 (CA19-9) in the combined group were (8.76±2.69) μg/L, (76.17±10.12)×103 U/L and (169.85±78.97)×103 U/L respectively, which were significantly lower than those of (12.46±3.47) μg/L, (104.56±14.38)×103 U/L, (312.45±71.36)×103 U/L in the chemotherapy group, with statistically significant differences (t=5.959, P<0.001; t=11.416, P<0.001; t=9.474, P<0.001). The clinical benefit rate and the total effective rate of the combined group were respectively 64.0% (32/50) and 88.0% (44/50), which were higher than those of 42.0% (21/50) and 72.0% (36/50) in the chemotherapy group, with statistically significant differences (χ2=4.857, P=0.028; χ2=4.000, P=0.046). The incidences of leukopenia, nausea and vomiting, constipation and alopecia of patients in the combined group were 20.0% (10/50), 24.0% (12/50), 30.0% (15/50) and 12.0% (6/50) respectively, which were 14.0% (7/50), 16.0% (8/50), 24.0% (12/50) and 8.0% (4/50) respectively in the chemotherapy group, with no statistically significant differences (χ2=0.638, P=0.424; χ2=1.000, P=0.317; χ2=0.457, P=0.499; χ2=0.444, P=0.505). Conclusion 3DCRT combined with thalidomide and GEMOX regimen can significantly reduce the levels of serum tumor markers in patients with advanced intrahepatic cholangiocarcinoma, enhance the shortterm efficacy without significantly increasing and aggravating adverse reactions.

Key words: Bile duct neoplasms, Antineoplastic combined chemotherapy protocols, Three-dimensional conformal radiotherapy technology, Thalidomide

张羽，徐滨，王冬梅. 3DCRT联合沙利度胺、GEMOX方案化疗对晚期肝内胆管细胞癌的疗效分析[J]. 国际肿瘤学杂志, 2019, 46(5): 262-266.

Zhang Yu, Xu Bin, Wang Dongmei. Curative effect analysis of 3DCRT combined with thalidomide and GEMOX regimen in advanced intrahepatic cholangiocarcinoma[J]. Journal of International Oncology, 2019, 46(5): 262-266.

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