| BackgroundEsophageal cancer is a common malignant tumor of the digestive system, surgery is the main treatment appraoch. However, early symptoms in esophageal cancer patients are not obvious, which makes it difficult for early, advanced stage diseases are usually found at diagnosis.For patients with locally advanced esophageal cancer who are not suitable for surgical treatment, concurrent chemoradiotherapy can be considered, but the 5-year survival rate of surgical treatment of esophageal cancer was around 25%, and long-term effect has not been significantly improved. Currently surgical treatment is still the main form for early esophageal cancer, but the location of esophagus and esophageal cancer radical surgery causes trauma and greater influence on the physiological function of patient; Medical researchers have begun to pay close attention to non-surgical initial treatment of the esophageal cancer which can maintain its physiological function. This treatment does not affect the overall treatment effect, and can relieve patients’ pain, save the esophagus physiological function and improve the quality of life. The clinical value of non-surgical treatment has been widely recognized. According to a study by KaTo H, after the concurrent chemoradiational treatment on stage I esophageal squamous cell carcinomas, the 4-years survival rate reached 80.5%, and relapse-free survival rate reached 68%. Early non-surgical treatment of esophageal is still improving, and non-operative therapy for advanced stage esophageal cancer are gradually standardized. In recent years, with the advent of three-dimensional conformal radiotherapy and intensity-modulated radiotherapy technology, the improvement of chemotherapy drugs as well as the rapid development of bio-medicine, concurrent chemoradiotherapy combined DC-CIK biotherapy has been drawing more and more attentions.ObjectiveTo study and discuss the expression level of T cell subgroup and clinical curative effect of concurrent chemoradiation combined with DC-CIK adoptive immunotherapy for patients with upper esophageal squamous cell carcinoma and those with stage Ⅰ-Ⅱ disease who don’t choose surgery,the progression-free survival rates were also analysed. The aim is to provide valuable influence for the diagnosis, treatment and prognosis of esophageal squamous cell carcinoma.MethodsEighty patients with stage Ⅰ-Ⅱ esophageal squamous cell carcinoma were devided into two groups at random:group A (42 cases) were treated using DC-CIK combined with concurrent chemoradiational therapy, and group B (38 cases) using chemotherapy treatment in the same period. The immune indexes before and after treatment in both groups, the change of serum CEA and CA19-9 indexes were analysed. Then, the evaluation of treatment effect, treatment response and quality of life of the two groups were compared. The patients’progression-free survival (PFS) according to the follow-up results of two groups was also discussed.ResultsSeventy-six patients completed the treatment in the two groups:41 cases in group A and 35 in group B. Four cases were unavailable because they could not tolerate the chemotherapy treatment or quited for personal reasons.1. Comparison of immune cells before and after treatment in the two groups: ① Before treatment, CD3+,CD3+CD4+, NK’s percentage difference was not statistically significant (P>0.05); after treatment, all the three indicators were rising, the percentage differences were statistically significant both within the group and between the groups(P< 0.05);②Treg percentage between the two groups were not statistically significant before treatment(P>0.05), but after treatment, the drop of these two figures was statistically significant(P<0.05).2. Cytokine comparison:① The two groups before treatment:cytokines IL-2, IL-6, IFN-gamma horizontal comparison, the difference was no statistically significant (P>0.05); ② Comparison between groups after treatment:IL-6 and IFN-gamma dropped and there was no statistically significant difference (P< 0.05) on IFN-gamma, but IL-6 went to the opposite side (P<0.05); IL-2 went up after treatment and there was significant difference both within the group and between the two groups.3. CEA and CA19-9 level comparison between the two groups after treatment in serum:inside the group, there was statistically significant difference (P<0.05); Comparison between groups, CEA and CA19-9 levels were statistically significant (P>0.05).4. The effective rate was 88.37% in group A and 88.57% in group B, there was no statistical significance (P>0.05); 1-,2-and 3-year overall survival rates of group A were:95.12%,78.04%,60.90%.1-year recurrence-free survival rates were 78.04%; 1-,2-and 3-year overall survival rate of group B were:94.28%,71.42%,57.14%,1-year recurrence-free survival rate was 74.29%.5. Major adverse reactions of two groups were bone marrow suppression, throat pain, mucocutaneous reactions, loss of appetite, trachea reactions. Incidences of bone marrow suppression, nausea and vomiting, radioactive esophagitis, and pharyngeal pain were 78.04%,82.92%,48.78%, and 29.26% in group A, and 80%,80%,51.42%, and 34.28% in group B.6. The quality of life score (QOL) in the patients was compared, there was no significant difference between the two groups before treatment. QOL was improved significantly after treatment in group A and the difference was statistically significant (P<0.05).7. The median Progression-free survival (PFS) was also compared:it was 32 months in group A and 24 months in group B. The difference was statistically significant (P<0.05).Conclusions1. According to the study, DC-CIK combined with concurrent chemoradiation therapy significantly improved the recent curative effect, progression-free survival and quality of li fe of esophageal cancerpatients who were not suitable for surgery, and the adverse reaction s can be tolerated, which is worth for further study.2. PFS got extended significantly in chemotherapy combined with DC-CIK bioimmun otherapy group compared with concurrent chemoradiotherapy group and the difference wa s statistically significant; and immune cells in peripheral blood within this group went up e xcept CD3+CD8+ which was not statistically significant; Treg cells decreased and the diffe rences were statistically significant; which can fully explain that the patient’s immune syste m may be improved and the ability to kill tumor cells can be enhanced. |
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