摘要
目的回顾性分析采用紫杉醇脂质体持续24 h或常规3 h静脉滴注联合奈达铂方案行根治性同步放化疗(definitive chemoradiotherapy,dCRT)与新辅助同步放化疗(neoadjuvant chemoradiotherapy,nCRT)的食管鳞状细胞癌(esophageal squamous cell carcinoma,ESCC)患者的疗效,为优化ESCC的治疗效果提供参考。方法回顾性分析南京大学医学院附属鼓楼医院肿瘤中心2017年2月至2019年9月行dCRT与nCRT的ESCC病例,纳入其中采用不同给药时长的紫杉醇脂质体联合奈达铂周方案同步化疗的病例。本研究的主要观察终点为近期疗效和总生存(overall survival,OS)时间,次要观察终点为无进展生存(progression-free survival,PFS)、治疗安全性和治疗失败模式。结果本研究共纳入33例患者,72.7%的患者行dCRT,27.3%的患者行nCRT。在dCRT患者中,临床完全缓解(clinical complete response,cCR)率为62.5%,中位OS时间为43.2个月,1年、2年和3年OS率分别为91.7%、70.8%和58.3%。在nCRT患者中,病理完全缓解(pathological complete response,pCR)率为44.4%,3年OS率为88.9%。紫杉醇脂质体持续24 h与3 h静脉滴注相比完全缓解率(cCR+pCR)和OS更具优势,但比较差异均无统计学意义(均P>0.05)。多因素分析发现,cCR是影响dCRT患者OS的独立预后因素(P<0.05)。发生率>5%的3级及以上的不良事件有白细胞减少、中性粒细胞减少、淋巴细胞减少和食管炎,无5级不良事件发生。结论紫杉醇脂质体联合奈达铂周方案化疗在ESCC同步放化疗中安全有效。紫杉醇脂质体持续24 h对比3 h静脉滴注,cCR率和OS率有提高的趋势。
Objective To evaluate the antitumor activity of liposomal paclitaxel,which was delivered continuously for 24 h or 3 h,and nedaplatin in definitive or neoadjuvant chemoradiotherapy of esophageal squamous cell carcinoma(ESCC).Method This study retrospectively analyzed ESCC patients treated with definitive or neoadjuvant chemoradiotherapy which applied liposomal paclitaxel and nedaplatin regime in the Comprehensive Cancer Center of Drum Tower Hospital,Medical School of Nanjing University from February 2017 to September 2019.The primary end point was clinical response and overall survival(OS),the secondary end points were progression-free survival(PFS),safety and treatment failure pattern.Result A total of 33 patients were included in the study,of which 72.7%(24/33)were treated with definitive chemoradiotherapy(dCRT),and 27.3%(9/33)were treated with neoadjuvant chemoradiotherapy(nCRT).The rate of clinical complete response(cCR),mOS,1-year,2-year and 3-year OS rate in dCRT were 62.5%,43.2 months,91.7%,70.8%and 58.3%respectively.The pCR rate and 3-year OS rate in nCRT were 44.4%and 88.9%.Compared with infusion over 3 h,patients with liposomal paclitaxel infusion over 24 h showed higher CR rates(cCR+pCR)and longer OS,but the differences were not statistically significant(all P>0.05).In the multi-variant COX analysis,cCR was the independent prognostic factor of OS in dCRT ESCC patients(P<0.05).In the safety analysis,the adverse event(AE)which above grade 3 and occurred more than 5%of patients were leukopenia,neutropenia,lymphopenia and esophagitis.There was no grade 5 AE occurred.Conclusion The regime of liposomal paclitaxel and nedaplatin is safe and effective in dCRT and nCRT.Compared with infusion over 3 h,patients with liposomal paclitaxel infusion over 24 h show superior tendency in cCR rate and OS of dCRT patients.
作者
吴浦嫄
祁亮
侯震
王涛
史敏科
闫婧
王立峰
刘宝瑞
任伟
Wu Puyuan;Qi Liang;Hou Zhen;Wang Tao;Shi Minke;Yan Jing;Wang Lifeng;Liu Baorui;Ren Wei(the Comprehensive Cancer Center of Drum Tower Hospital,Medical School of Nanjing University,Nanjing 210008,China;Department of General Thoracic Surgery,Drum Tower Hospital,Medical School of Nanjing University,Nanjing 210008,China)
出处
《肿瘤综合治疗电子杂志》
2022年第3期78-84,共7页
Journal of Multidisciplinary Cancer Management(Electronic Version)
基金
吴阶平医学基金会临床科研专项基金(320.6750.2021-01-36)
鼓楼医院新技术发展基金项目(XJSFZJJ202035)
白求恩•中青年医师科研能力培养项目(BQE-TY-SSPC(7)-N-01)。
关键词
食管鳞状细胞癌
同步放化疗
紫杉醇脂质体
持续静脉滴注
Esophageal squamous cell carcinoma
Chemoradiotherapy
Liposomal paclitaxel
Continuous infusion
