| Objective: to evaluate the efficacy and side effects of concurrent chemoradiotherapy combined with nituzumab in the treatment of esophageal cancer.Methods: 72 cases of esophageal cancer treated in our hospital from August 2016 to August 2017 were prospectively and randomly selected as the research objects.Divide it randomly into two groups.In the control group,36 patients were treated with chemotherapy-infusion combined with synchronous intensity-modulated radiotherapy,while in the observation group,36 patients were treated with concurrent chemoradiotherapy combined with nituzumab,The curative effect,quality of life,adverse reactions and prognostic factors were compared between the two groups.Results: compared with the control group,the efficacy and quality of life of the observation group were better,with statistical differences(P < 0.05).Univariate and multivariate analyses showed that functional status score,concurrent chemoradiotherapy,radiotherapy dose,GTV and operation to recurrence time were all related to the prognosis of patients.There was no significant difference in side effects between the observation group and the control group(P < 0.05).The survival indexes of the two groups were observed,Conclusion: concurrent chemoradiotherapy combined with nituzumab in the treatment of esophageal cancer patients can achieve significant results,tolerable toxic and side effects,can promote patients to complete the treatment,can improve the quality of life of patients,and the development of treatment plan should be considered to affect the prognosis of related factors.In recent years,Chinese people’s dietary habits have changed significantly,and the number of smokers and alcoholics has increased compared with before.In addition,serious food hygiene problems make the incidence of esophageal cancer in China more and more high.Esophageal cancer is difficult to treat and easy to relapse.,in clinical diagnosis in patients with esophageal cancer are already in the middle-late stage,the majority of patients often lost the operation chance,intensity modulated radiation therapy(imrt)and is one of the main methods of treatment of esophageal cancer,but the postoperative recurrence seriously affected the surgical curative effect,although simple radiotherapy can temporarily alleviate patients,but the effect is not obvious,intensity modulated radiation therapy(imrt)perfusion chemotherapy combined synchronization in recent years has become the main way of treatment of esophageal cancer,in order to improve the level of clinical treatment,medical focus on study of targeted therapy in patients with esophageal cancer(1 ~ 3].The main carcinogenic factors of esophageal cancer are ammonium nitrite,the incidence of esophageal cancer is higher in people who often eat pickles and people who smoke for a long time,mainly because the carcinogens such as nitrosamines are gradually accumulated in patients,increasing the incidence of patients.Esophageal cancer is a progressive process,such as alcohol and other irritating substances will cause irritation to the food mucosa and damage it.Under the influence of long-term alcoholism,smoking and other factors,the damage to the food mucosa is continuous and progressive aggravation.Whether radical surgery or postoperative radiotherapy is performed for esophageal cancer,the local recurrence rate of patients is very high,and the quality of life is significantly affected.With the research of molecular biology in recent years,China and Brazil jointly developed a new drug of nituzumab as a targeted therapy,which was confirmed by multiple prospective,multicenter randomized clinical studies,and several phase I and phase ii clinical studies confirmed the safety of nituzumab combined with radiotherapy.Nituzumab combined with radiotherapy or chemoradiotherapy has been shown to be clinically beneficial in improving overall survival(OS)and progression-free survival(PFS)in patients with head and neck cancer.In November 2008 to July 2010,the relevant research in China’s state food and drug administration(CFDA)approval of phase II clinical trials,including phase II(not surgery or reject)to stage IV(supraclavicular lymph node metastasis only)in patients with esophageal duly accept nim bead single resistance combined radiotherapy,most of the patients in the study of the previously refused to chemotherapy,and other patients can’t tolerate chemotherapy,multicenter phase II study is to determine the purpose of nim figure single safety and efficacy of combined radiotherapy in the treatment of esophageal cancer,This trial has been registered in cancer institute of Chinese academy of medical sciences and hospital(CAMS)according to good clinical practice,and confirmed that the combination of nituzumab and radiotherapy can be used as a highly effective and low-toxicity treatment method,which is of great value in improving the survival period and quality of life of patients with esophageal cancer.According to the investigation,concurrent chemoradiotherapy has the characteristics of increasing sensitivity of radiotherapy,wide anticancer activity,high concentration in tumor cells,and light toxicity.Intensity-modulated radiotherapy(imrt)can keep the radiation field and target area in the same shape.The irradiation amount to normal tissue is very small,and the tumor area can be increased simultaneously.In addition,the therapeutic effect can be enhanced by the combination of chemotherapy and radiotherapy with common chemotherapy drugs that are sensitive to cancer cells,have broad anticancer spectrum and have no cross-drug resistance.The recurrence of arterial perfusion chemotherapy is used for local treatment,which can well block the corresponding tumor vascular obstruction,without obvious trauma to the patient.The corresponding operation time is short,and the patient’s tolerance is also significantly improved,without obvious damage to the nearby normal parts.For this reason,336 cases of esophageal cancer patients admitted to our hospital from August 2016 to August 2017 were selected in this study,who were treated with concurrent chemoradiotherapy combined with nituzumab,and significant results were obtained.The relevant studies are as follows.Esophageal cancer is caused by many factors,including high incidence,high mortality and easy recurrence of esophageal epithelial lesions.In China due to geographical diet and environmental factors,there is a difference between the incidence of esophageal cancer in various areas have obvious difference,including esophageal carcinogenic factors are mainly the ammonium nitrate,people often eat sour pickled cabbage and long-term smokers have higher incidence of esophageal cancer,mainly because of nitrosamines carcinogens,such as savings gradually accumulated in the body,patients with increased risk(5 ~ 7).Esophageal cancer is a progressive process,such as alcohol and other irritating substances will cause irritation to the food mucosa and damage it.Under the influence of long-term alcoholism,smoking and other factors,the damage to the food mucosa is continuous and progressive aggravation.Regardless of radical surgery or postoperative radiotherapy for esophageal cancer,the local recurrence rate of patients is higher,and the corresponding life and health are significantly affected.Patients’ quality of life is seriously affected by the negative impact of repeated illness.Therefore,multidisciplinary treatment is a recognized treatment method,which can inhibit the Epidermal growth factor Receptor(Epidermal growth factor Receptor)by means of targeted therapy,concurrent radiotherapy and chemotherapy.Egfr-mediated tumor cell proliferation and apoptosis can also improve local recurrence with combined chemoradiotherapy,which is very important to improve the quality of life of patients.Although concurrent radiotherapy and chemotherapy can enhance the curative effect in clinical studies and have good long-term curative effect and positive effect on prolonging the survival time of patients,it still has a high risk in clinical practice.Serious complications after radiotherapy,including massive hemorrhage and perforation of the esophagus,can cause a decline in the quality of life of patients after treatment and seriously affect the prognosis.Therefore,we should pay close attention to patients’ complaints and adverse feelings before radiotherapy,and take active preventive measures and rescue preparation.In addition,wang liquan [17] showed that there was only one case of blood pressure drop in the toxic side effects caused by nituzumab,and the incidence of radioactive esophagitis and bone marrow suppression was high,which was also consistent with the phenomenon of no blood pressure drop,radioactive esophagitis and bone marrow suppression in this study.Duly,bead sheet resistance to a lower incidence of rash,to improve patients’ tolerance,and because he completed bead single humanized resistance degree is higher,which in turn,this bead sheet resistance caused by the human anti mouse antibody response will decrease,chemoradiation combination,appropriate to the side effects of bead sheet resistance to treatment was not increased compared with chemoradiation its side reaction,have higher security,compared to foreign drug bevacizumab effect the treatment of advanced esophageal cancer with radiation and chemotherapy,and Cuba in a study in recent years also duly confirmed,bead single joint chemoradiation resistance with good effectiveness and safety.At present,most patients with lung cancer,especially those with advanced lung cancer,generally choose radiotherapy,chemotherapy and combination therapy in the treatment process.According to the experience in this regard,comprehensive treatment can well hinder the growth of primary and secondary tumors,and reduce the recurrence rate of tumors,which is beneficial to improve the treatment effect.Under this mode of treatment,the life of patients is also significantly prolonged,so it has a high value of application.However,concurrent chemoradiotherapy combined with nituzumab still has certain toxic and side effects,so it is necessary to do a good job in allergy examination,and give preventive infection measures and targeted nursing measures.Through predictive care and early provision of specialized care to prevent the occurrence of adverse reactions after treatment,and the correct drug administration needs to increase the degree of attention.Emphasis on specialization and individualization of comprehensive nursing measures,in order to reduce the side effects of patients,especially of intensity modulated radiation therapy(imrt)synchronous cause radioactive esophagitis,gastrointestinal reaction and bone marrow suppression,can adopt the method of negative psychological intervention,through targeted education according to individual patients case,deep communication,and communication with the patient,personality characteristics and psychological characteristics of the patients with in-depth understanding,adopt supportive psychological intervention measures to adjust the negative psychological status of patients,against the patient’s belief.Counseling personnel can clear the stasis of patients’ emotions through emotional regulation,avoid emotional physical examination of negative emotions,master the psychological characteristics of patients,and provide personalized support treatment for patients with severe psychological symptoms with appropriate counseling skills.Duly,bead sheet resistance has the possibility of an anaphylactic reaction,should through the predictive nursing measures and giving medicine is closely monitoring,and on the base of preventing radiation and chemotherapy adverse reactions will care focused on improvements in the patient’s mental state,by encouraging patients and staff to design interventions,strengthening the patient’s independent problem solving ability,enhance patients’ self-efficacy and improve patients confidence,thus make the physiological state of the patients more health [18 ~ 21].Esophageal cancer is caused by many factors,including high incidence,high mortality and easy recurrence of esophageal epithelial lesions.In China due to geographical diet and environmental factors,there is a difference between the incidence of esophageal cancer in various areas have obvious difference,including esophageal carcinogenic factors are mainly the ammonium nitrate,people often eat sour pickled cabbage and long-term smokers have higher incidence of esophageal cancer,mainly because of nitrosamines carcinogens,such as savings gradually accumulated in the body,patients with increased risk(5 ~ 7).Esophageal cancer is a progressive process,such as alcohol and other irritating substances will cause irritation to the food mucosa and damage it.Under the influence of long-term alcoholism,smoking and other factors,the food mucosa damage is continuous and progressive aggravation.Regardless of radical surgery or,postoperative radiotherapy for esophageal cancer,the local recurrence rate of patients is higher,and the corresponding life and health are significantly affected.Patients’ quality of life is seriously affected by the negative impact of repeated illness.Therefore,multidisciplinary treatment is a recognized treatment method,which can inhibit the Epidermal growth factor Receptor(Epidermal growth factor Receptor)by means of targeted therapy,concurrent radiotherapy and chemotherapy.Egfr-mediated tumor cell proliferation and apoptosis can also improve local recurrence with combined chemoradiotherapy,which is very important to improve the quality of life of patients.Studies have shown that targeted treatment of EGFR has significant effects on a variety of cancers with abnormally high EGFR expression on the tumor surface,mainly because both EGFR and its receptor are involved in many processes of tumor cell growth,proliferation and apoptosis,and its expression is closely related to the sensitivity of tumor chemoradiotherapy.Studies have shown that positive expression rate of EGFR in esophageal tissue between 50% ~ 69%,and high expression of EGFR not only associated with the malignant degree of tumor,also has the characteristics of more resistant to chemotherapy,such as taking steps to make its mediated signal transduction pathway is blocked,can by blocking the cell cycle development play a role of inducing tumor cell apoptosis,and to inhibit tumor angiogenesis,reduce tumor invasion ability play an important role.Nituzumab is a recombinant humanized monoclonal antibody targeted at EGFR,developed in cooperation with China and Cuba,which can occupy the epitope of EGFR molecule by virtue of its specific binding to EGFR and thereby achieve competitive inhibition of egfr-ligand binding.Studies have shown that human EGFR monoclonal antibody nituzumab can inhibit EGFR natural ligand epidermal growth factor(EGF)and transformed growth factor(TGF)binding through competitive inhibition,thus effectively inhibiting egfr-mediated signal transmission and cytological effects.After the cytological effect of EGFR is inhibited,its role in promoting tumor cell proliferation and tumor angiogenesis will be blocked.In addition to promoting the proliferation and apoptosis of tumor cells by inhibiting the mechanism of EGFR,nituzumab can also play a role in inhibiting tumor growth and metastasis in the treatment process based on antibody-dependent cell-mediated cytotoxicity(ADCC)and complement dependent cytotoxicity(DCD).Studies have shown that,this bead sheet has lower resistance S period the biosynthesis of tumor cells and regulation of cell proliferation cycle,make tumor cells stay in F1 period,and then reach the target of radiation and chemotherapy sensitivity,and can through regulatory mechanisms such as apoptosis factors inducing tumor cell apoptosis,reduce the resistance of tumor cells to improve their sensitivity to drugs,effectively inhibit tumor growth and metastasis,improve curative effect.Studies have shown that nituzumab,as a monoclonal antibody against epidermal factor receptor,has a synergistic effect of chemoradiotherapy on head and neck squamous cell carcinoma.This study,through adopting appropriate bead sheet resistance combined chemoradiation has obtained the good result,effective treatment reached 80.56%,Fei Li rise and ling-xin meng [15],and other people in the choice of research on rizhao city in shandong province people’s hospital between January 2012 and January 2013,98 patients were taken,this bead sheet resistance with chemoradiation therapy,patients with locally advanced esophageal cancer the recent curative effect of total effective rate reached 81.8%,and the study results are basically identical.Esophageal cancer is a kind of malignant tumor that is easy to relapse and metastasis after treatment.Some studies have analyzed the main factors of local uncontrolled and mediastinal lymph node metastasis,and one of the reasons may be related to the occurrence of radiotherapy indications in patients without receiving radiotherapy.Studies have shown that postoperative radiotherapy can improve the median survival and reduce lymph node metastasis in patients with late T staging.In addition,individual heterogeneity,jump infiltration of esophageal cancer,and biological characteristics of multi-point origin all lead to the recurrence of esophageal cancer.Nituzumab is a recombinant humanized antibody targeting EFGR,which can enhance the sensitivity of radiochemotherapy and has a good inhibitory effect on local recurrence and metastasis.In this study,interventional arterial chemotherapy perfusion and nituzumab antibiotic combination contract pacing intensive radiotherapy were used for the treatment of esophageal cancer during feeding,with significant efficacy and no serious adverse reactions,and predictive intervention and professional response measures were used to effectively reduce the incidence of adverse reactions.Because the proliferation of esophageal cancer cells is not continuous,and showed a jump and easy to relapse with this characteristic,in view of the characteristics of tumor cells concentrated in the local,arterial chemotherapy perfusion can significantly increase the drug concentration,in the local drug,can quickly kill a lot of tumor cells.In the combined treatment mode,necrotic zone will appear in the tumor area and block the blood supply to the tumor.Cancer can be found in all parts of the esophagus,and the relatively small arteries that supply blood to the esophagus increase the difficulty of surgery.Synchronous radiotherapy and chemotherapy can provide certain convenience for surgery,and also be beneficial to improve the cure rate,and can well meet the treatment requirements of esophageal cancer with fewer blood types.Concurrent radiotherapy and chemotherapy can also avoid the trauma caused by surgery,preserve organ function,and have a good impact on the prognosis and quality of life of patients.For multi-branch blood supply in clinical treatment,accurate positioning can be conducted on the basis of arteriography,so as to reduce the rate of intubation error [16].3.4 toxic and side effects and corresponding preventive measuresAlthough concurrent radiotherapy and chemotherapy can enhance the curative effect in clinical studies and have good long-term curative effect and positive effect on prolonging the survival time of patients,it still has a high risk in clinical practice.Serious complications after radiotherapy,including massive hemorrhage and perforation of esophagus,can cause a decline in the quality of life of patients after treatment and seriously affect the prognosis.Therefore,we should pay close attention to patients’ complaints and adverse feelings before radiotherapy,and take active preventive measures and rescue preparation.In addition,wang liquan [17] showed that there was only one case of blood pressure drop in the toxic side effects caused by nituzumab,and the incidence of radioactive esophagitis and bone marrow suppression was high,which was also consistent with the phenomenon of no blood pressure drop,radioactive esophagitis and bone marrow suppression in this study.Duly,bead sheet resistance to a lower incidence of rash,to improve patients’ tolerance,and because he completed bead single humanized resistance degree is higher,which in turn,this bead sheet resistance caused by the human anti mouse antibody response will decrease,chemoradiation combination,appropriate to the side effects of bead sheet resistance to treatment was not increased compared with chemoradiation its side reaction,have higher security,compared to foreign drug bevacizumab effect the treatment of advanced esophageal cancer with radiation and chemotherapy,and Cuba in a study in recent years also duly confirmed,bead single joint chemoradiation resistance with good effectiveness and safety.At present,most patients with lung cancer,especially those with advanced lung cancer,generally choose radiotherapy,chemotherapy and combination therapy in the treatment process.According to the experience in this regard,comprehensive treatment can well hinder the growth of primary and secondary tumors,and reduce the recurrence rate of tumors,which is beneficial to improve the treatment effect.Under this mode of treatment,the life of patients is also significantly prolonged,so it has a high value of application.However,concurrent chemoradiotherapy combined with nituzumab still has certain toxic and side effects,so it is necessary to do a good job in allergy examination,and give preventive infection measures and targeted nursing measures.Through predictive care and early provision of specialized care to prevent the occurrence of adverse reactions after treatment,and the correct drug administration needs to increase the degree of attention.Emphasis on specialization and individualization of comprehensive nursing measures,in order to reduce the side effects of patients,especially of intensity modulated radiation therapy(imrt)synchronous cause radioactive esophagitis,gastrointestinal reaction and bone marrow suppression,can adopt the method of negative psychological intervention,through targeted education according to individual patients case,deep communication,and communication with the patient,personality characteristics and psychological characteristics of the patients with in-depth understanding,adopt supportive psychological intervention measures to adjust the negative psychological status of patients,against the patient’s belief.Counseling personnel can clear the stasis of patients’ emotions through emotional regulation,avoid emotional physical examination of negative emotions,master the psychological characteristics of patients,and provide personalized support treatment for patients with severe psychological symptoms with appropriate counseling skills.Duly,bead sheet resistance has the possibility of an anaphylactic reaction,should through the predictive nursing measures and giving medicine is closely monitoring,and on the base of preventing radiation and chemotherapy adverse reactions will care focused on improvements in the patient’s mental state,by encouraging patients and staff to design interventions,strengthening the patient’s independent problem solving ability,enhance patients’ self-efficacy and improve patients confidence,thus make the physiological state of the patients more health [18 ~ 21].Gastrointestinal reaction induced by chemotherapy,namely nausea and vomiting,is a common complication in the treatment of concurrent chemoradiotherapy combined with nituzumab.To this end,should take the medicine before the vein injection antiemetic drugs combined diet nursing and other predictive nursing measures.Radioactive esophagitis and one of the main side effect of esophageal cancer radiation therapy often appear,its performance after swallowing pain,chest pain,and eating obstruction,such as feeling through the environment,to create a good diet for patients with light digestible diet and instruct patients complement moisture,pay attention to diet,the choice of reasonable collocation food,staple food should choose fiber food less,choose high quantity of heat,high protein,high vitamin,not greasy and low-fat digestible food,by fully supply nutrition to meet the needs of the body.After radioactive esophagitis should give priority to with pap,semifluid or liquid diet,food temperature should be controlled at about 39 ℃advisable,avoid crumb and viscous foods incarcerated at esophageal stricture and obstruction(22 ~ 25).In addition,myelosuppression is the most common side effect of concurrent chemoradiotherapy combined with nituzumab in the treatment of esophageal cancer.In order to avoid the thrombocytopenia caused by myelosuppression,corresponding predictive nursing measures should be taken.When the number of platelets is lower than 20X109/L,patients should be immediately instructed to have a bed rest,avoid brushing their teeth with a bristle brush,pay attention to details of life,reduce all kinds of puncture and avoid bleeding.During puncture,pressure should be applied on the puncture site to stop bleeding for more than 5 minutes.After medication,the number of platelets was also detected,and patients were instructed not to exert too much force when defecating,to keep defecation unobstructed,and to exercise reasonably,and to avoid too intense exercise.By closely monitoring the changes in the number of platelets,observing whether the patient has gingival bleeding,etc.,and observing the clinical status of the patient,the judgment and vigilance of whether the patient has intracranial bleeding symptoms[26~28]。... |
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