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HIFU联合吉西他滨同步化疗及DC-CIK治疗中晚期胰腺癌临床疗效分析
作者:许涛  景红霞  曹风军  雷金华  邰云燕  李勇  狄全书  度龙  向龙超 
单位:湖北医药学院附属人民医院肿瘤中心  湖北 十堰 442000 湖北医药学院附属人民医院超声科  湖北 十堰 442000 
关键词:胰腺肿瘤/治疗 超声 高强聚焦 经肠 树突细胞 杀伤细胞 抗肿瘤药/治疗应用 脱氧胞苷/治疗应用 脱氧胞苷/类似物和衍生物 治疗结果 
DOI:R735.9;R730.5
出版年,卷(期):页码:2018,33(5):416-420
摘要:

目的 高强度聚焦超声(high intensity focused ultrasound,HIFU)同步吉西他滨化疗联合树突状细胞-细胞因子诱导的杀伤细胞免疫疗法(dendritic cells-cytokine-induced killer cell immunotherapy,DC-CIK)治疗中晚期胰腺癌的临床疗效及不良反应。方法 20例中晚期胰腺癌患者先行HIFU同步吉西他滨化疗,序贯DC-CIK免疫治疗。吉西他滨800~1 000 mg/m2,d1、d8,3周为1个周期,共4~6个周期。HIFU和化疗同步进行,5次/周,治疗2周间歇1周,共治疗4周。结果 CD3+CD4+T淋巴细胞、CD3+CD8+ T淋巴细胞和CD56+自然杀伤(natural killer,NK)细胞比例及CD4+/CD8+细胞比率治疗前、后比较,差异均具有统计学意义(均P<0.05)。疼痛缓解率为73.3%。治疗前、后疼痛评分分别为(5.07±2.55)和(2.00±1.36),KPS评分分别为(73.00±6.57)和(85.5±10.50),治疗前、后疼痛评分及KPS评分比较,差异均具有统计学意义(均P<0.05)。所有患者部分缓解10例,疾病稳定5例,疾病进展5例,总有效率为50.0%。中位生存期为14个月,1年总生存率为62.7%,中位无进展生存期为8个月,1年无进展生存率为11.4%。不良反应为中性粒细胞减少Ⅰ级8例、Ⅱ级8例、Ⅲ级4例,血小板减少Ⅰ级5例、Ⅱ级2例、Ⅲ级1例,恶心、呕吐Ⅰ级15例、Ⅱ级5例。结论 对于中晚期胰腺癌患者,HIFU同步吉西他滨化疗联合DC-CIK细胞治疗可缓解疼痛,提高生活质量,疗效确切,不良反应可以耐受。

Objective To evaluate the clinical efficacy and adverse effects of high intensity focused ultrasound (HIFU) combined with concurrent gemcitabine chemotherapy and dendritic cell-cytokine induced killer cell immunotherapy (DC-CIK) in the treatment of advanced pancreatic cancer. Methods Twenty patients with advanced pancreatic cancer were enrolled in the study. All patients were treated with HIFU and concurrent gemcitabine,followed by DC-CIK immunotherapy. Gemcitabine was administrated at 800-1 000 mg/m2 on d1 and d8 for 3 weeks as one cycle,and repeated for 4-6 cycles. HIFU was performed concurrently with the chemotherapy,for five times a week. One-week interval was scheduled after every 2-week HIFU treatment,with 4 weeks therapy in total. Results The percentages of CD3+CD4+ T lymphocyte,CD3+CD8+ T lymphocyte,CD56+ NK cells and the ratio of CD4+/CD8+ were changed significantly after the treatment,compared with those before the treatment (P<0.05). The pain relief rate was 73.3% and the pain scores were decreased from 5.07±2.55 to 2.00±1.36; the KPS scores were increased from 73.00±6.57 to 85.5±10.50 after treatment (both P<0.05). Among 20 patients,10 achieved PR,5 were SD,and 5 were PD,with an overall effective rate of 50%. The medium survival time and the medium progression-free survival were 14 months and 8 months respectively; the 1-year survival rate and 1-year progression-free survival rate were 62.7% and 11.4% respectively. The adverse effects included:grade Ⅰ neutropenia (n=8),grade Ⅱ neutropenia (n=8),grade Ⅲ neutropenia (n=4); grade Ⅰ thrombocytopenia (n=5),grade Ⅱ thrombocytopenia (n=2),grade Ⅲ thrombocytopenia (n=1); grade Ⅰ nausea/vomiting (n=15),and grade Ⅱ nausea/vomiting (n=5). Conclusion HIFU combined with concurrent gemcitabine and sequential DC-CIK can relieve the pain and enhance the quantity of life in advanced pancreatic cancer patients,with significant clinical effects and tolerable adverse reactions.

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