Clinical Observation Of Continuous Intravenous Pumping Rh-endostatin Combined With Concurrent Chemoradiotherapy In The Treatment Of Locally Advanced Cervical Squamous Cell Carcinoma

Objective: This study explored the clinical application value of continuous intravenous pumping of rh-endostatin combined with concurrent chemoradiotherapy（CCRT）on locally advanced cervical squamous cancer.The efficacy and safety of rh-endostatin combined with CCRT and CCRT in the treatment of LACSC patients were compared,as well as the expression level of vascular endothelial growth factor-A（VEGF-A）.Methods: In this study,91 patients with LACSC were enrolled in the First Affiliated Hospital of Anhui Medical University from June 2019 to December 2020 in a prospective,randomized,controlled clinical design.48 patients were randomly assigned to the CCRT+E group,and received CCRT combined with continuous intravenous pumping rhendostatin.43 patients in CCRT group were treated with CCRT.After treatment,the two groups were compared in terms of short-term efficacy,acute toxicity and side effects,changes in hematological routine indicators and tumor-specific indicators,and changes in VEGF-A expression level in patients.Results: In terms of short-term efficacy,the objective response rates of CCRT+E group and CCRT group were 93.75% vs 90.70%,and the disease control rates were 95.93% vs 95.35%,respectively,with no statistical difference（all P > 0.05）.However,the complete response rate in CCRT+E group was significantly higher than that in CCRT group（83.33% vs 65.12%,P < 0.05）.One month after treatment,in terms of routine hematological indicators,white blood cells and platelets in the CCRT group were significantly decreased compared with before treatment（all P < 0.05）,and hemoglobin in two groups was significantly decreased compared with before treatment（P < 0.05）,but there was no significant difference in the decrease of hemoglobin between groups（P > 0.05）.In terms of tumor specific indexes,SCCag,CEA and CYFRA21-1 in two groups were significantly decreased compared with before treatment（all P < 0.05）,but there was no significant difference in the decrease of the three indexes between groups（all P > 0.05）.After treatment,the expression level of VEGF-A in two groups was significantly decreased compared with before treatment（P < 0.05）,but there was no significant difference in the decreased level of VEGF-A between groups（P > 0.05）.In terms of safety,there were some differences in the incidence of drug-related acute adverse effects between two groups,but drug-related acute adverse effects were mainly concentrated in grade 1-2,and there was no significant difference in the incidence of radiation-related acute adverse effects.The incidence of neutropenia,hypertension and infection in CCRT+E group was higher than that in CCRT group（68.75% vs 44.19%,16.67% vs 2.33%,50.00%vs 18.60%,respectively）,but the incidence of nausea was lower（41.67% vs 60.47%）（P < 0.05）.Multivariate analysis showed that the differences in the incidence of four acute adverse effects were mainly related to treatment groups.Conclusions: Continuous intravenous pumping rh-endostatin combined with CCRT in the treatment of LACSC patients has improved the short-term efficacy,mainly the CR rate.The acute side effects related to treatment are generally controllable,but the differential acute side effects caused by rh-endostatin should be paid attention to.Although the expressions of cervical cancer-related tumor markers and VEGF-A were significantly decreased in patients,no inhibition effect of tumor markers and VEGF-A was further improved by rh-endostatin based on CCRT.