| Background and objectivesEsophageal cancer is one of the most common malignant digestive system tumors in China.It is easy to infiltrate other tissues and organs.It is very aggressive and has a very high degree of malignancy,and the prognosis is very poor.With the rising incidence of esophageal cancer in recent years,it has gradually become one of the major malignant diseases which construt a serious threat to human health and life.Among all kinds of malignant tumors in China,the morbidity of esophageal cancer ranked the sixth,and the mortality was occupied the fourth.The incidence of esophageal cancr has obvious regional characteristics,and China is also one of the high incidence areas of esophageal cancer,regardless of morbidity or mortality are in the third place just after gastric cancer and liver cancer among malignant tumors of digestive system.Squamous cell carcinoma and adenocarcinoma are the main and representative histological type of esophageal cancer,and squamous cell carcinoma is the main form of esophageal cancer in China,the main risk factors for the incidence of esophageal cancer are tobacco and alcohol.At present,the main treatment methods of esophageal cancer are surgical,chemotherapy and radiotherapy,a multi-mode comprehensive treatment means is usually used to treat the esophageal cancer.If the esophageal tumor can be surgically removed,and the patient can tolerate the case,surgery is the primary treatment,because of its early metastasis and spread,the majority of patients has been advanced when diagnosed clearly,which loss the optimal time for surgical treatment,radiotherapy and chemotherapy have become the important treatment.At present,cisplatin combined with fluorouracil is considered to be the standard and commonly used treatment of esophageal cancer,but the improvement of its efficacy is not ideal,toxic side effects are also heavier.In recent years,paclitaxel has been increasingly used in the treatment of advanced esophageal cancer,which is considered to be one of the effective drugs in the treatment of esophageal cancer.Thalidomide is a non-barbiturate sedative earliest used to treat early pregnancy reaction,and later because it can cause significant fetal malformations and was prohibited.In recent years,a number of studies suggest that thalidomide has anti-tumor effect,its mechanism is mainly anti-tumor angiogenesis,induction of apoptosis,immune regulation and so on.At present,thalidomide has been clinically used in the adjuvant therapy for advanced esophageal cancer,liver cancer,small cell lung cancer,non-small cell lung cancer,glioma and malignant melanoma and so on,and it is a potential and promising anti-tumor drugs.The aim of this study was to retrospectively analyze the therapeutic effects of 70 patients with advanced esophageal squamous cell carcinoma from Apirl 2014 to Apirl 2015 in the department of oncology of the First Affiliated Hospital of Zhengzhou University,patients were respectively treated with thalidomide combined with chemotherapy or simple chemotherapy,the main observation indicators for the study were recent efficacy,survival rate,median survival time,improvement of quality of life and tolerance to drug-related adverse reactions,and so as to provide a definite theoretical basis for the choice of treatment for patients with esophageal cancer.MethodsThe study was conducted in the study of seventy patients with advanced esophageal squamous cell carcinoma confirmed by pathology or cytology from April 2014 to April 2015 in the department of oncology of our hospital.TNM staging of patients were all Ⅳ period;the first anti-tumor treatment;Panofsky performance status was over 70;Could be into the semi-liquid or smoothly into the liquid diet,no severe cachexia and cardiovascular disease,and no tracheal invasion and perforation X-ray signs;more than one measurable lesions could be used to evaluate the effect of treatment with imaging examination;expected survival time more than 3 months.Seventy patients were randomly divided into two groups according to the ratio of 1: 1.The patients in the control group were treated with paclitaxel combined with cisplatin.The patients in the experimental group were treated with thalidomide on the basis of the control group.All patients were told in detail the possible adverse reactions and the relevant matters needing attention in the process of chemotherapy before treatment begins.In the event of an intolerable drug-related adverse reaction,chemotherapy was terminated in time.ResultAfter the end of two cycles of chemotherapy for the patients in experimental group and control group,the number of the patients who could be assessed in the recent efficacy is seventy.Experimental group: complete remission(CR)is one cases,partial remission(PR)is fourteen cases,stable disease(SD)is fifteen cases,progressive disease(PD)is five cases,the disease control rate(DCR)was 85.7%(30/35);Control group: complete remission(CR)is zero cases,partial remission(PR)is thirteen cases,stable disease(SD)is sixteen cases,progressive disease(PD)is six cases,the disease control rate(DCR)was 82.9%(29/35);The disease control rate were compared between the experimental group and the control group,there was no significant difference between the two groups(P> 0.05).In the improvement of quality of life,compared with the control group,the panofsky performance status,the improvement of sleep and weight change in the experimental group had obvious advantages,and there was significant difference between the two groups(P <0.05).Adverse reactions were mainly hematologic toxicity(leukopenia,thrombocytopenia,hemoglobin reduction),gastrointestinal toxicity(nausea,vomiting)and so on,adverse reactions between the two groups were mainly grade Ⅰ~ Ⅱ.The incidence of gastrointestinal reactions such as nausea and vomiting in the experimental group was lower than that in the control group,the difference between the groups were statistically significant(χ2 = 5.757,P = 0.016 <0.05);The incidence of constipation in the experimental group was higher than that in the control group,the difference were statistically significant(χ2 = 7.124,P = 0.008 <0.05);Other adverse events were compared,the incidence between the two groups was no significant difference(P> 0.05).During the course of treatment,the toxic and side effects of the patients in the experimental group and the control group were controlled by the clinical symptomatic treatment,and there were no drug-related side effects that caused treatment to stop and no treatment-related death.Until the date of follow-up,the median survival time of the experimental group and control group respectively were 11.0 months(95%CI: 9.267-12.733)and 10.0 months(95%CI: 8.344-11.656),there was no significant difference between the two groups(P> 0.05).The 1-year survival rates of the experimental group and the control group respectively were 40.0%,31.4%,the difference between the two groups was not statistically significant(P> 0.05).Conclusion1.Thalidomide combined with chemotherapy in the treatment of advanced esophageal squamous cell carcinoma can significantly improve the quality of life of patients,improve the compliance with chemotherapy.2.Thalidomide combined with chemotherapy in the treatment of advanced esophageal squamous cell carcinoma can significantly reduce the incidence of nausea,vomiting and other gastrointestinal reactions,adverse reactions can be tolerated,thalidomide for the treatment of esophageal cancer is worthy of further study and promotion. |
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