项目来源

山东省科技计划

项目主持人

韩大力

项目受资助机构

山东省肿瘤防治研究院

项目编号

2015GSF118017

立项年度

2015

立项时间

未公开

研究期限

未知 / 未知

项目级别

省级

受资助金额

24.00万元

学科

人口与健康

学科代码

未公开

基金类别

重点研发计划项目

关键词

食管鳞癌 ; 放疗 ; 化疗 ; 失败模式 ; 分子影像 ; 挽救性治疗 ; Esophageal squamous cell carcinoma ; radiotherapy ; chemotherapy ; failure mode ; molecular imaging ; salvage therapy

参与者

未公开

参与机构

未公开

项目标书摘要：食管鳞癌在分子影像指导的治疗模式下，根治性放化疗后失败的具体模式较少为临床肿瘤学家所知晓。本研究拟利用分子示踪剂FDG进行显像定量分析食管鳞癌根治性放化疗后失败病灶，以指导挽救性治疗的实施。本研究于2014年5月至2015年12月累计入组患者39例，排除各种原因未按照既定治疗方案完成及失访的患者，共30例纳入本研究分析。分别对患者进行FDG PET-CT检查，准确定位根治性放、化疗后失败的食管鳞癌病灶的位置，确定病灶个数并测量最大标准摄取值(SUVmax)、代谢体积(MTV),按食管癌的解剖位置，构建失败模式分布图，对局部失败的具体位置、淋巴结转移部位、远处转移的器官进行详细标注。根据患者的体力状态、病变范围，分别进行实施包括手术、再程放化疗、单纯放疗、化疗及最佳支持治疗的挽救性治疗手段。Kaplan-Meier法计算生存率并Log-rank法检验，分析SUVmax及MTV对患者生存率的影响。结果：随访率达100%,根治性放化疗后失败的食管鳞癌患者的挽救性治疗包括手术2例、再程放化疗18例、单纯放疗4例、化疗2例及最佳支持治疗2例；放射性皮肤反应1级8例,2级5例，无3、4级皮肤反应发生；放射性肺损伤1级2例,2级4例，无3、4级放射性肺损伤发生；未观察到放射性心脏和脊髓损伤的患者。近期反应率46.67%,中位生存时间为8个月,2年OS为23.33%。本研究发现经过筛选的失败患者进行挽救性手术治疗取得了较好的2年OS,而能接受放化疗者明显优于单纯放疗或单纯化疗者，接受最佳支持治疗的患者预后最差。分组分析显示,SUVmax和MTV较低的一组生存时间长于较高者。该结论的得出同时受到样本量较小的影响，可能存在偏倚。本研究的结论有待于纳入更多样本量的证实及补充，同时，可以根据不同的SUVmax、MTV进行进一步分层分析。

Application Abstract: The specific mode of failure after radical chemoradiotherapy is less known by clinical oncologists under the molecular imaging guidance of esophageal squamous cell carcinoma.In order to guide the implementation of radical chemoradiotherapy,the molecular tracer FDG was used to quantitatively analyze the failure of esophageal squamous cell carcinoma after radical radiotherapy and chemotherapy.Methods:from May 2014 to December 2015,a total of 39 patients were enrolled in this study,excluded from various studies,30 patients were enrolled in the final analyse,enventually.Were FDG PET-CT examination on the patients,accurate positioning of radical radiotherapy and chemotherapy after failure of esophageal squamous cell carcinoma lesion location,determine the number of lesions and to measure the maximum standard uptake value(SUVmax),volume(MTV),according to the metabolic anatomic location of esophageal cancer,construction of failure mode distribution,the local failure location lymph node metastasis and distant metastasis of organs site,detailed notes.According to physical condition and range of disease,salvage treatment including operation,rechemotherapy,radiotherapy,chemotherapy and best supportive treatment were carried out.The Kaplan-Meier method was used to calculate the survival rate and the Log-rank test.The effect of SUVmax and MTV on the survival rate of patients was analyzed.Results:the follow-up rate was 100%,2 cases,2 cases of re chemotherapy in 18 cases,4 cases with radiotherapy and chemotherapy in 2 cases and best supportive therapy as salvage therapy in patients with esophageal squamous cell carcinoma after radical radiotherapy and chemotherapy after failure including surgery;radioactive skin reaction grade 1 8 cases,grade 2 in 5 cases,no 3 grade 4,grade 1 skin reaction;2 cases of radiation-induced lung injury,4 cases of grade 2,3 grade 4,without the occurrence of radiation-induced lung injury;no radioactivity was observed in heart and spinal cord injury patients.The response rate was 46.67%,the median survival time was 8 months,and the 2 year OS was 23.33%.Conclusion:This study found that after screening failure underwent salvage surgery achieved 2 years OS,and chemotherapy is superior to radiotherapy or chemotherapy,the prognosis of patients receiving best supportive care is the worst.Group analysis showed that a lower group of SUVmax and MTV had longer survival than the higher.The conclusion is influenced by the smaller sample size,and there may be bias.The conclusions of this study need to be included in the confirmation and supplement of more samples.At the same time,further stratification analysis can be carried out according to different SUVmax and MTV.

项目受资助省

山东省