調強適形放療聯合替吉奧對無法手術老年胃癌患者免疫學指標及不良反應的影響

徐鎮錢 趙嗣鈺

[摘要]?目的?研究調強適形放療聯合替吉奧對無法手術的老年胃癌患者免疫學指標及不良反應的影響。方法?選取2015年1月至2021年12月臺州市腫瘤醫院住院的老年胃癌患者100例，采用隨機數字表法分為對照組（n=50）和觀察組（n=50）。對照組進行替吉奧單一治療，觀察組在此基礎上聯合調強適形放療。比較兩組疾病控制率（disease?control?rate，DCR）以及兩組治療前后免疫學指標CD3+、CD4+、CD8+、CD4+/CD8+的變化，對比兩組不良反應發生率。結果?觀察組的DCR顯著高于對照組（P<0.05）。治療后，兩組患者CD8+顯著低于治療前（P<0.05），CD3+、CD4+、CD4+/CD8+顯著高于治療前（P<0.05）；治療后觀察組患者CD8+顯著低于對照組（P<0.05），CD3+、CD4+、CD4+/CD8+顯著高于對照組（P<0.05）；觀察組的不良反應發生率顯著低于對照組（P<0.05）。結論?調強適形放療聯合替吉奧用于無法手術的老年胃癌患者，可提高疾病控制效果，且不良反應較低，值得臨床普及應用。

[關鍵詞]?調強適形放療；替吉奧；胃癌

[中圖分類號]?R735.2??????[文獻標識碼]?A??????[DOI]?10.3969/j.issn.1673-9701.2023.17.013

Effect?of?moderated?conformal?radiotherapy?combined?with?tegafur，?gimeracil?and?oteracil?on?immunological?parameters?and?adverse?effects?in?inoperable?elderly?gastric?cancer?patients

XU?Zhenqian1，?ZHAO?Siyu2

1.Department?of?Oncology?Radiotherapy，?Taizhou?Cancer?Hospital，?Taizhou?317502，?Zhejiang，?China;?2.Department?of?Oncology，?Taizhou?Cancer?Hospital，?Taizhou?317502，?Zhejiang，?China

[Abstract]?Objective?To?investigate?the?effects?of?moderated?conformal?radiotherapy?combined?with?tegafur，?gimeracil?and?oteracil?on?immunological?indicators?and?adverse?effects?in?inoperable?elderly?patients?with?gastric?cancer.?Methods?A?total?of?100?elderly?patients?with?gastric?cancer?hospitalized?in?Taizhou?Cancer?Hospital?from?January?2015?to?December?2021?were?selected?and?divided?into?control?group?（n=50）?and?observation?group?（n=50）?according?to?the?random?number?table?method.?The?control?group?was?treated?with?tegafur，?gimeracil?and?oteracil?monotherapy，?and?the?observation?group?was?treated?with?combined?intensity-modulated?conformal?radiotherapy?on?this?basis.?Compared?the?disease?control?rate?（DCR），?and?the?changes?in?immunological?indicators?CD3+，?CD4+，?CD8+?and?CD4+/CD8+?before?and?after?treatment?between?the?two?groups，?and?compared?the?incidence?of?adverse?reactions?between?the?two?groups.?Results?DCR?of?the?observation?group?was?significantly?higher?than?that?of?the?control?group?（P<0.05）.?After?treatment，?CD8+?was?significantly?lower?in?both?groups?than?before?treatment?（P<0.05），?and?CD3+，?CD4+?and?CD4+/CD8+?were?significantly?higher?in?both?groups?（P<0.05）.?After?treatment，?CD8+?was?significantly?lower?in?the?observation?group?than?that?in?the?control?group?（P<0.05），?and?CD3+，?CD4+?and?CD4+/CD8+?were?significantly?higher?than?those?in?the?control?group?（P<0.05）.?The?incidence?of?adverse?reactions?was?significantly?lower?in?the?observation?group?than?that?in?the?control?group?（P<0.05）.?Conclusion?Intensity-modulated?radiotherapy?combined?with?tegafur，gimeracil?and?oteracil?for?inoperable?elderly?patients?with?gastric?cancer?can?improve?disease?control?with?low?adverse?effects，?and?is?worthy?of?widespread?clinical?application.

[Key?words]?Intensity-modulated?conformal?radiotherapy;?Tegafur，gimeracil?and?oteracil;Gastric?cancer

胃癌是臨床常見的惡性腫瘤之一，有研究指出，近年來我國胃癌的發病率及死亡率顯著上升，有年輕化趨勢[1]。目前臨床對胃癌發病因素研究存在較多爭議，多認為與飲食結構、幽門螺桿菌（helicobacter?pylori，Hp）感染、遺傳及地域環境等有關。胃癌患者的早期癥狀缺乏特異性，部分患者可出現嘔吐、惡心及上消化道癥狀，老年胃癌患者發病更為隱匿[2]。目前臨床對胃癌治療以手術根治、化療及放療為主，其中手術根治主要針對早期胃癌患者，但多數患者確診時已進展至中晚期[3]。化療是無法手術胃癌患者的首選治療方案，其中口服替吉奧臨床療效顯著，但有較多患者不良反應嚴重，無法耐受，故效果欠佳[4]。調強適形放療可提高放療劑量及放療體積的精確度，在多種惡性腫瘤疾病治療中取得了顯著成果，但目前臨床關于調強適形放療聯合替吉奧對無法手術的老年胃癌患者臨床療效尚未形成統一定論[5]。……