摘要
目的观察高剂量少分次放疗治疗胰腺癌前后,免疫功能、营养及体力状态的变化。方法前瞻性收集空军特色医学中心拟行胰腺癌放疗患者,采用螺旋断层放疗系统治疗,胰腺病灶PTV、CTV、GTV分别为70 Gy、60 Gy、50 Gy,15或20次,治疗前和治疗结束后均接受检测血液淋巴细胞百分比、体液免疫指标(IgG、IgA、IgM、C_(3)、C_(4))、细胞免疫指标(CD_(3)、CD_(4)、CD_(8))及血液营养相关指标(血红蛋白、白蛋白、白球比),并评价体力状态(KPS),采用配对t检验比较治疗前后参数值差异。结果共入组34例,患者治疗前血液淋巴细胞比率低于正常值的例数为8(23.5%)例,疗后34(100%)例。治疗前体液免疫参数IgG、IgA、IgM、C_(3)及C_(4)值低于正常值的例数分别为0、0、2(5.9%)、7(20.6%)、1(2.9%)例,治疗后IgG、IgA、IgM、C_(3)及C_(4)值低于正常值的例数分别为1(2.9%)、0、7(20.6%)、6(17.6%)、0例。治疗前细胞免疫指标CD_(3)、CD_(4)百分比值低于正常值的例数均为1(2.9%)例,CD_(8)高于正常值的例数为2例(5.9%),治疗后细胞免疫指标各参数例数不变。淋巴细胞比率平均降低63.0±20.6%(P<0.001),IgM值平均降低9.6±17.5%(P=0.011),其余免疫参数治疗前后均无统计学差异(P>0.05)。治疗前营养状态指标血红蛋白、白蛋白及白球比低于正常值的例数分别为7(20.6%)、4(11.8%)、0(0)例,治疗后分别为8(23.5%)、4(11.8%)、0(0)例,治疗前后均无统计学差异。KPS评分疗后较前改善占44.1%(15例),稳定占44.1%(15例)。结论胰腺癌高剂量少分次放疗对患者的免疫功能有一定影响,对营养及体力影响小。
Objective To observe the changes of immune function,nutritional status,and performance status in patients after high-dose hypofractionated radiotherapy for pancreatic cancer.Methods We prospectively collected patients with pancreatic cancer who would undergo radiotherapy with helical tomotherapy at our hospital.A total dose of 50/60/70 Gy in 15 or 20 fractions was delivered to the PTV,CTV,and GTV,respectively.Lymphocyte percentage,humoral immunity indexes(IgG,IgA,IgM,C_(3),and C_(4)),cellular immunity indexes(CD_(3)+,CD_(4)+,and CD_(8)+T cells),nutrition related indexes(hemoglobin,albumin,and albumin to globulin ratio),and physical status(KPS)were evaluated before and after radiotherapy.The paired t-test was used to compare the difference in the immune indicators before and after treatment.Results A total of 34 patients were enrolled in the study.The number of patients with a lower lymphocyte percentage than normal was 8(23.5%)before treatment and 34(100%)after treatment.The numbers of patients with lower IgG,IgA,IgM,C_(3),and C_(4)were 0,0,2(5.9%),7(20.6%),and 1(2.9%),respectively,before treatment;the corresponding numbers after treatment were 1(2.9%),0,7(20.6%),6(17.6%),and 0.The numbers of patients a lower CD_(3)+T cell percentage,lower CD_(4)+T cell percentage,and higher CD_(8)+T cell percentage were 1(2.9%),1(2.9%),and 2(5.9%),respectively,both before and after treatment.The lymphocyte percentage was decreased by 63.0±20.6%(P<0.001)and IgM was decreased by 9.6±17.5%on average(P=0.011);the other parameters had no statistical difference before and after treatment.Before treatment,the numbers of cases with lower hemoglobin,albumin,and albumin to globulin ratio were 7(20.6%),4(11.8%),and 0(0)before treatment and 8(23.5%),4(11.8%),and 0(0)after treatment,respectively;there was no statistical difference in these paramters before and after treatment.After treatment,the KPS score was improved in 44.1%(15 cases)and stable in 44.1%(15 cases).Conclusion High-dose hypofractionated radiotherapy for pancreatic cancer has appreciated effect on the immune function of patients,but has little effect on the nutritional and performance status of patients.
作者
任刚
沈光凯
宋佳钊
李晶
王勇
王颖杰
Ren Gang;Shen Guangkai;Song Jiazhao;Li Jing;Wang Yong;Wang Yingjie(Department of Radiotherapy,Peking University Shougang Hospital,Beijing 100144,China;Air Force Medical Center,Beijing 100142,China)
出处
《中华临床医师杂志（电子版）》
CAS
北大核心
2022年第9期876-880,共5页
Chinese Journal of Clinicians(Electronic Edition)
基金
首都卫生发展科研专项项目(2022-2-5121)
空军军医大学学校临床研究项目(2021LC2227)
关键词
胰腺癌
高剂量少分次放疗
免疫功能
营养状态
体力状态
Pancreatic cancer
High-dose hypofractionated radiotherapy
Immune function
Nutritional status
Performance status
