本文選題：宮頸癌 + 重組人血管內皮抑制素��； 參考：《大連醫(yī)科大學》2014年碩士論文

【摘要】：背景與目的：宮頸癌為女性最常見的生殖系統(tǒng)腫瘤，居女性死亡原因的第三位,每年全世界約有接近274,000的婦女死于該疾病，嚴重威脅著婦女健康。由于宮頸癌起病隱匿，確診時多已進展為中晚期疾病。放射治療為中晚期宮頸癌的主要治療手段。盡管隨著醫(yī)學影像技術和放療技術方面的發(fā)展，明顯提高了腫瘤靶區(qū)適形度和劑量，同時周圍正常組織和器官受照劑量及體積較前有降低。但中晚期宮頸癌的總生存率仍在50%左右，較前并無顯著提高。單純放療不能阻斷腫瘤細胞的擴散與轉移，腫瘤局部未控、復發(fā)、淋巴結轉移及遠處轉移是治療失敗的主要原因。對局部腫瘤、全身轉移及潛在轉移灶進行綜合治療是目前宮頸癌的主要研究方向之一。近年來，多個隨機臨床研究結果顯示，與單純放療相比，以順鉑為基礎的同步放化療能明顯改善中晚期宮頸癌患者的生存率。但是同步放化療的治療方法不能有效解決腫瘤的擴散與轉移問題，所以近年來對于中晚期宮頸癌采用放化療的基礎上加用阻斷血管生成的藥物成為研究的熱點。重組人血管內皮抑制素是我國自主研發(fā)的血管內皮抑制素藥物。該藥能夠使血管內皮細胞的增殖和遷移受到明顯且特異性地抑制，從而使為腫瘤的生長和轉移提供營養(yǎng)物質的新生血管的形成收到抑制。同時，有研究表明恩度還可以抑制淋巴結的轉移及淋巴管的新生。目前恩度聯(lián)合化學治療已作為一線方案用于轉移性結直腸癌、胃癌及進展期非小細胞肺癌的治療，顯示出良好的治療效果及耐受性。本文回顧性分析了我院收治的56例中晚期宮頸癌患者，比較分析了恩度聯(lián)合同步放化療與同步放化療的近期療效及急性毒副反應。 方法：對56例2011年1月-2013年12月在大連醫(yī)科大學附屬第二醫(yī)院腫瘤放療科首次接受治療的中晚期宮頸癌患者的臨床資料進行了回顧性分析。將其分為同步放化治療組（以下稱對照組）和同步放化聯(lián)合恩度組（以下簡稱恩度組）。對照組29例，年齡30-74歲，中位年齡52歲。恩度組27例，年齡34-75歲，中位年齡53歲。一般資料比較兩組患者的差異無統(tǒng)計學意義（P0.05）。對照組采用盆腔三維適形放療、腔內后裝治療同步單藥順鉑化療。恩度組除給予上述治療外，還聯(lián)合恩度進行治療。近期療效的評價在患者治療結束后3個月，，根據患者的臨床檢查結果及盆腔MRI/CT檢查結果進行評價。評價標準依據實體瘤治療療效評價標準RECIST進行判斷。在治療過程中及治療結束后3個月內記錄患者的骨髓抑制、直腸反應、胃腸道反應及泌尿生殖道反應等早期并發(fā)癥的發(fā)病情況，不良反應的分級依據RTOG急性放射損傷分級標準進行評價。 結果：治療結束后3個月，對照組完全緩解16例（55.17%），部分緩解9例（31.03%），病變穩(wěn)定2例（6.90%），有效率（CR+PR）86.21%。恩度組完全緩解17例（62.96%），部分緩解8例（29.63%），病變穩(wěn)定1例（3.70%），有效率（CR+PR）92.59%。恩度組的完全緩解率（CR%）高于對照組，但差異沒有統(tǒng)計學意義（2=0.351，P＞0.05）。恩度組的有效率[（CR+PR）%]高于對照組，差異也沒有統(tǒng)計學意義（2=0.596，P＞0.05）。急性不良反應方面，恩度組與對照組中骨髓抑制發(fā)生率分別為59.26%（16/27）和62.07%（18/29）、直腸反應發(fā)生率分別為25.93%（7/27）和31.03%（9/29），差異均無統(tǒng)計學意義（P＞0.05）。兩組胃腸道反應分別為66.66%（18/27）和62.07%（18/29）、泌尿生殖道反應發(fā)生率分別是18.52%（5/27）和20.69%（6/29），差異均無統(tǒng)計學意義（P＞0.05）。 結論：本研究表明，同步放化療聯(lián)合重組人血管內皮抑制素用于中晚期宮頸癌患者，其治療有效率較同步放化療有所提高，且不良反應沒有增加。因此此種聯(lián)合治療方法有希望成為有效治療中晚期宮頸癌的新模式。
[Abstract]:Background and purpose: cervical cancer is the most common reproductive system tumor in women. It is the third cause of female death. Nearly 274000 of the women worldwide die of the disease every year. It is a serious threat to the health of women. Although with the development of medical imaging technology and radiotherapy technology, the conformability and dose of tumor target area have been improved obviously, while the dose and volume of normal tissues and organs in the surrounding tissues and organs are lower than before. However, the total survival rate of middle and late cervical cancer is still around 50%, and no significant improvement has been made. Proliferation and metastasis of cells, local uncontrolled tumor, recurrence, lymph node metastasis and distant metastasis are the main causes of treatment failure. Comprehensive treatment of local tumors, whole body metastases and potential metastases is one of the main research directions for cervical cancer. In recent years, multiple randomized clinical studies have shown that compared with simple radiotherapy, the results show that Platinum based concurrent chemoradiotherapy can significantly improve the survival rate of patients with advanced and advanced cervical cancer. However, the treatment of concurrent chemoradiotherapy can not effectively solve the problem of tumor diffusion and metastasis. Therefore, in recent years, the use of chemotherapy and chemotherapy on the basis of chemotherapy and chemotherapy has become a hot topic in the study. Endostatin (endostatin) is a self-developed endostatin in our country. The drug can inhibit the proliferation and migration of vascular endothelial cells obviously and specifically, so that the formation of new blood vessels that provide nutrients for the growth and metastasis of the tumor is suppressed. Present grace combined chemical therapy has been used as a first-line scheme for the treatment of metastatic colorectal cancer, gastric cancer and advanced non small cell lung cancer, showing good therapeutic effect and tolerance. This paper reviewed 56 cases of middle and advanced cervical cancer patients in our hospital and analyzed the combination of degree of grace. The short-term efficacy and acute toxicity of concurrent chemoradiotherapy and concurrent chemoradiotherapy.
Methods: the clinical data of 56 patients with advanced cervical cancer, which were first treated in the Radiotherapy Department of the second hospital affiliated to Dalian Medical University, January 2011 -2013, were analyzed. The clinical data were divided into synchronous radiotherapy group (the lower control group) and the synchrotron synchrotron group (hereinafter referred to as the endo group). The control group was 29. For example, the age of 30-74 years, the median age of 52 years, 27 cases of grace group, age 34-75, middle age 53 years. General data compared to the two groups of patients with no statistically significant difference (P0.05). The control group was treated with pelvic three-dimensional conformal radiotherapy, intracavitary post loading treatment with single drug cisplatin chemotherapy. The evaluation of the outcome was evaluated at 3 months after the end of the patient's treatment, according to the results of the patient's clinical examination and the results of the pelvic MRI/CT examination. The evaluation criteria were based on the standard RECIST for the treatment of solid tumors. During the treatment and in the 3 months after the treatment, the patient's myelosuppression, the rectal reaction, the gastrointestinal reaction and the treatment were recorded. The incidence of early complications such as genitourinary tract reaction and grading of adverse reactions were evaluated according to RTOG acute radiation injury classification standard.
Results: 3 months after the end of the treatment, 16 cases (55.17%) were completely remission in the control group, 9 cases (31.03%), 2 cases (6.90%), 17 cases (62.96%), 8 cases (29.63%) and 55.17% cases (3.70%), and the complete remission rate (CR%) of the effective (CR+PR) 92.59%. group (CR%) was higher than that of the control group, but the rate of complete remission (CR%) was higher than the control group, but the rate of the total remission rate of the effective (CR+PR) 92.59%. group was higher than the control group. The difference was not statistically significant (2=0.351, P > 0.05). The efficiency of the degree group [(CR+PR)%] was higher than that of the control group (2=0.596, P > 0.05). The incidence of myelosuppression in the group and the control group was 59.26% (16/27) and 62.07% (18/29), respectively, and the incidence of rectal reaction was 25.93% (7/27) and 31., respectively. The difference of 03% (9/29) was not statistically significant (P > 0.05). The gastrointestinal reactions in the two groups were 66.66% (18/27) and 62.07% (18/29) respectively. The incidence of genitourinary reaction was 18.52% (5/27) and 20.69% (6/29) respectively, and the difference was not statistically significant (P > 0.05).
Conclusion: This study shows that the combination of concurrent chemoradiotherapy and recombinant human vascular endostatin for patients with middle and advanced cervical cancer is more effective than synchronous radiotherapy and chemotherapy, and the adverse reaction does not increase. Therefore, this combined therapy is hopeful to be a new model for effective treatment of middle and late cervical cancer.

【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.33

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