Clinical Observation Of Endostar Combined With Chemoradiotherapy For Patients With Locally Advanced Esophageal Carcinoma And Effect On Serum VEGF

Objective and backgroundEsophageal carcinoma(EC), the most common malignant tumor in digestivesystem, has threatened people’s health and lives with high incidence, aggressive andpoor prognosis. Surgical excision together with radiotherapy and chemotherapyremain the traditional approaches in the treatment of EC. However, over two-thirds ofpatients are diagnosed with advanced esophageal carcinoma and unfit to undergooperation. As a result of it, the prognosis is not favorable. Multiple clinical studieshave proved the efficacy of concurrent Chemoradiotherapy(CCRT) in treatment oflocal advanced EC and improved the survival rate of patients with T1–3N0–1M0tumors despite of the low five survival rate of about30%. How to further improve theeffect of CCRT has becomes a central issue recently.Some experimental and clinical investigations now focus on the anti-angiogenicapproach which has the ability of tumor regression by inhibiting the formation of newtumor vasculature and improving tumor hypoxia. Whether the addition ofanti-angiogenic drugs can improve the tumor response to CCRT and have positiveimpact on the prognosis of tumor treatment become the main research direction.Recombinant human endostatin (Endostar) is considered as one of the mostpotential endothelial cell inhibitors of antiangiogesis developed by our country.Endostar is reported to inhibit tumor growth without displaying toxic side effects anddrug resistance. Since the promising outcome of Endostar combined chemotherapy inpatients with advanced non-small cell lung cancer(NSCLC) by improving theprogression free and overall survival, Endostar has been approved for the treatment ofNSCLC by the State Food and Drug Administration in China. But it is still unclear about the effect of Endostar in patients with esophageal squamous cell carcinoma(ESCC). Our research is to evaluate the efficacy of Endostar in the treatment ofESCC by analyzing the outcomes of combined with Endostar CCRT in patients withlocally advanced ESCC and the effects on the expression of serum VEGF level.MethodsThe study involved55patients with locally advanced esophageal carcinomabetween January2009and February2011in the department of Radiotherapy in theFirst Affiliated Hospital of Zhengzhou University. All patients underwent endoscopicevaluation with biopsy and were diagnosed with squamous cell carcinoma. Karnofskyscore≥70, the estimate survival time＞6months, no severe cardiovascular disease, nokidney or liver damage, no inflammatory bowel disease and coagulation disorders andno distant metastasis. no sevious radiation and chemotherapy contraindications.28patients treated with Endostar plus CRT(E group) and27patients with CRT(C group).All the patients received three-dimensional conformal radiotherapy of60-66Gy andconcurrent chemotherapy of5fluorouracil and cisplatin. Endostar was administeredat a dose level of7.5mg/m2/d on the day of CRT （d1-14）and2cycles are given.The response rate(RR), progression free survival(PFS), overall survival rate(OS) andside effects were assessed after treatment. The serum VEGF (S-VEGF) levels weremeasured before and after the treatment in both groups.Statistic methods: we used SPSS17.0statistic software to process and analysis data.Chi-square test was used to analysis the response rate; the progression free andoverall survival rates were calculated by the Kaplan–Meier method and the log-ranktest was used to analysis the significance of differences in survival. A p-value of0.05was considered significant.Results1. The follow-up rate was91%in55patients. The RR in E group was89%and74.1%in C group（P>0.05）.The1,2,3OS rate were71.9%,50%,34.3%and52%,33.3%,20%, and there were differences showed by log-rank test（P<0.05）while thePFS and MST were15mo、19mo and8mo、12.5mo for E group and C group respectively. The difference was statistically significant（P<0.05）.2. The follow-up rate was91%in55patients. The RR in E group was89%and74.1%in C group（P>0.05）.The1,2,3OS rate were71.9%,50%,34.3%and52%,33.3%,20%, and there were differences showed by log-rank test（P<0.05）while thePFS and MST were15mo、19mo and8mo、12.5mo for E group and C grouprespectively. The difference was statistically significant（P<0.05）.3. The incidences of toxicity in both groups were relatively high, mainlygastrointestinal complications, blood toxicity and radiation pharyngeal inflammation,but no significant difference.ConclusionEndostar combined with chemoradiotherapy can improve the outcomes ofpatients with locally advanced Esophageal Squamous Cell Carcinoma and reduce theS-VEGF level in ESCC patients while adverse effects were not raised.