Curative effect analysis of 3DCRT combined with thalidomide and GEMOX regimen in advanced intrahepatic cholangiocarcinoma

Abstract

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

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.

References

［1］陈嘉佳, 李文岗. 《2016年欧洲胆管癌研究网络共识：胆管细胞癌研究现状及前景展望》摘译［J］. 临床肝胆病杂志, 2016, 32(10): 1847-1850. DOI: 10.3969/j.issn.1001-5256.2016.10.004. ［2］马旭辉, 苗振静, 李霞, 等. 沙利度胺联合GEMOX方案治疗中晚期肝癌的临床观察［J］. 实用癌症杂志, 2011, 26(5): 498-499, 503. DOI: 10.3969/j.issn.1001-5930.2011.05.019. ［3］吴陈新, 徐萍, 强铭, 等. 三维适形放疗联合CIK细胞治疗晚期原发性肝癌患者的疗效［J］. 安徽医学, 2016, 37(10): 1217-1221. DOI: 10.3969/j.issn.1000-0399.2016.10.008. ［4］王琴, 张东成, 董超, 等. 三维适形放疗放射野布局对治疗原发性肝癌患者放射性肝损伤的影响［J］. 实用肝脏病杂志, 2017, 20(3): 366-367. DOI: 10.3969/j.issn.1672-5069.2017.03.032. ［5］陈骏, 毛谅, 何健, 等. 第8版《美国癌症联合会肿瘤分期手册》肝内胆管细胞癌TNM分期解读［J］. 中华消化外科杂志, 2017, 16(4): 330-335. DOI: 10.3760/cma.j.issn.16739752.2017.04.003. ［6］冷玲, 佟仲生. 对实体瘤疗效评价标准的再认识［J］. 国际肿瘤学杂志, 2008, 35(5): 343-346. DOI: 10.3760/cma.j.issn.1673-422X.2008.05.007. ［7］李桂源, 熊炜, 武明花, 等. 现代肿瘤学基础［M］. 北京: 科学出版社, 2011: 185-192. ［8］ Ng SY, Colborn KL, Cambridge L, et al. Acute toxicity with intensity modulated radiotherapy versus 3dimensional conformal radiotherapy during preoperative chemoradiation for locally advanced rectal cancer［J］. Radiother Oncol, 2016, 121(2): 252-257. DOI: 10.1016/j.radonc.2016.09.010. ［9］熊肇明, 蒋逊, 钱明平, 等. 胆管癌的病因及诊断分析［J］. 中华老年多器官疾病杂志, 2006, 5(4): 299. DOI: 10.3969/j.issn.1671-5403.2006.04.019. ［10］ Dumitru R, Carbunaru A, Grasu M, et al. Pseudoaneurysm of the splenic arteryan uncommon cause of delayed hemorrhage after pancreaticoduodenectomy［J］. Ann Hepatobiliary Pancreat Surg, 2016, 20(4): 204-210. DOI: 10.14701/ahbps.2016.20.4.204. ［11］韩超, 靳龙洋, 翟天宇, 等. 术前肿瘤标志物检测对肝内胆管细胞癌淋巴结转移的预测价值［J］. 中华消化外科杂志, 2017, 16(5): 503-507. DOI: 10.3760/cma.j.issn.1673-9752.2017.05.013. ［12］赵福英, 余芃, 邓友松, 等. 胆管癌血清肿瘤标志物及临床意义［J］. 检验医学与临床, 2016, 13(21): 3114-3116. DOI: 10.3969/j.issn.1672-9455.2016.21.054. ［13］余宗阳, 欧阳学农, 陈樟树, 等. 吉西他滨联合卡培他滨治疗41例复发或转移性胆管细胞癌的临床疗效和安全性观察［J］. 中华肿瘤杂志, 2008, 30(2): 144-146. DOI: 10.3321/j.issn:02533766.2008.02.017. ［14］吴燕丽, 曾晖, 王智勇. 吉西他滨不同给药方案联合奥沙利铂治疗复发转移性胆管癌的临床观察［J］. 中国药房, 2017, 28(27): 3794-3797. DOI: 10.6039/j.issn.1001-0408.2017.27.14. ［15］苏小琴, 徐爱兵, 王建红, 等. 沙利度胺联合吉西他滨及奥沙利铂方案治疗中晚期肝癌的临床对照研究［J］. 胃肠病学和肝病学杂志, 2012, 21(7): 604-606. DOI: 10.3969/j.issn.1006-5709.2012.07.005. ［16］ Zhao J, Hu W, Cai G, et al. Dosimetric comparisons of VMAT, IMRT and 3DCRT for locally advanced rectal cancer with simultaneous integrated boost［J］. Oncotarget, 2016, 7(5): 6345-6351. DOI: 10.18632/oncotarget.6401. ［17］ Gkika E, Hallauer L, Kirste S, et al. Stereotactic body radiotherapy (SBRT) for locally advanced intrahepatic and extrahepatic cholangiocarcinoma［J］. BMC Cancer, 2017, 17(1): 781. DOI: 10.1186/s12885-017-3788-1.

[1]	Jiang Xi, Wu Yongcun, Liang Yan, Chu Li, Duan Yingxin, Wang Lijun, Huo Junjie.Impact of pembrolizumab combined with chemotherapy on angiogenesis and circulating endothelial cells in patients with advanced non-small cell lung cancer[J]. Journal of International Oncology, 2024, 51(2): 89-94.
[2]	Huang Hui, Ding Jianghua.Advances in targeting FGFR2 for treatment of advanced cholangiocarcinoma[J]. Journal of International Oncology, 2023, 50(9): 569-573.
[3]	An Rong, Liu Meihua, Wang Peichen, Wang Xiaohui.Research progress of Nrf2 in ovarian cancer[J]. Journal of International Oncology, 2023, 50(8): 493-497.
[4]	Zhou Weiwen, Sun Xiaonan.Research progress of radiotherapy in extrahepatic cholangiocarcinoma[J]. Journal of International Oncology, 2020, 47(7): 431-435.
[5]	Hou Lina, Dina Suolitiken, Guo Zhi, Chen Xiao, Ren Hua.Comparison of efficacy and safety of PD-1 inhibitor monotherapy and combined with chemotherapy/targeted therapy in advanced malignant tumors[J]. Journal of International Oncology, 2020, 47(4): 193-198.
[6]	Xue Dong, Xia Xiuliang, Song Dekun, Xiang Tinghai, Wang Jianqiang, Gong Bengang.Expression and clinical significance of cullin 4A in cholangiocarcinoma[J]. Journal of International Oncology, 2019, 46(3): 153-156.
[7]	Zhang Baoyou, Wang Tiejun.Progress of radiotherapy for vulvar cancer[J]. Journal of International Oncology, 2019, 46(11): 699-704.
[8]	Wang Gang, Wang Huangzhen, Xue Ting.Effect of oxaliplatin induced autophagy on drug resistance of SGC7901 gastric cancer cells[J]. Journal of International Oncology, 2018, 45(8): 513-518.
[9]	WU Xin, QU Xiu-Juan, ZHANG Ling-Yun.Antitumor therapy of thalidomide[J]. Journal of International Oncology, 2018, 45(8): 490-493.
[10]	Wang Dazhong.Effect of platinum based dual drug secondline therapy on prognosis of NSCLC patients and relative factors analysis[J]. Journal of International Oncology, 2018, 45(5): 269-272.
[11]	Ni Chuandou, Song Chunfeng, Yang Mingjun, Xing Peng, Zhang Wei.Progress in the study of preoperative evaluation and surgical treatment of hilar cholangiocarcinoma[J]. Journal of International Oncology, 2018, 45(11): 692-695.
[12]	Zou Rongji, Ma Qingjiu.Research progress on body fluids microRNAs in the diagnosis of cholangiocarcinoma[J]. Journal of International Oncology, 2017, 44(4): 300-303.
[13]	LEI Lei, WANG Xian, WANG Xiao-Jia.Research progress of thalidomide in usual nonhematologic malignancies[J]. Journal of International Oncology, 2016, 43(8): 711-714.
[14]	Li Kaichun, Wang Jingwen, Shi Zhan, Zhuang Jie, Chen Xi, Chen Jiayan, Tang Xi, Li Jin.Efficacy and safety of aprepitant combined with ondansetron and dexamethasone in the prevention of chemotherapyinduced nausea and vomiting[J]. Journal of International Oncology, 2016, 43(8): 561-564.
[15]	Gao Haiyan, Zhu Yulan, Sun Li.Investigation of the curative effect of chemotherapy combined with DC-CIK cell immunotherapy in metastatic breast carcinoma[J]. Journal of International Oncology, 2016, 43(5): 326-329.