| ObjectiveLung tumors are the common form of malignant tumor,which can be divided into non-small cell lung cancer and small cell lung cancer.The former accounts for 80%to 85%.In China,the morbidity and mortality of lung cancer rank first in malignant tumors.According to statistics,there were 733,000 new cases of lung cancer and 610,000 deaths in 2015 in China,which seriously affected the health of Chinese residents.Although more and more researchs about lung cancer have been carried out in recent years,the survival and prognosis of patients with lung cancer are still poor,which is due to its diverse etiology,lack of early specific symptoms and signs,and relative resistance to radiotherapy and chemotherapy.The 5-year survival rate is only 13.9%to 29%.At present,the standard treatment for stage III non-small cell lung cancer is concurrent chemoradiotherapy,but the tumor cells cannot be completely eliminated.The 5-year survival rate of patients is still very low,and tumor recurrence and metastasis arise within a few months in many patients.Therefore,how to help these locally advanced patients to extend survival time,reduce recurrence and metastasis rate,and improve life quality is an urgent problem to be solved in clinical work at present,and it is also the research hotspot in recent years.Apatinib mesylate,a domestic oral small-molecule multi-target antitumor angiogenesis drug,mainly inhibits tumor angiogenesis by inhibiting tyrosine kinase VEGFR-2,exerting its antitumor effect.Apatinib mesylate has a clear antitumor effect in researchs of advanced gastric cancer,kidney cancer,ovarian cancer,etc.In recent years,its application in patients with advanced NSCLC has been increasing,but the efficacy especially when combined with concurrent radiochemotherapy is still unclear.In this study,we compared the short-term,long-term effects,and adverse reactions of non-small-cell lung cancer with concurrent radiotherapy and chemotherapy with concurrent radiotherapy and apatinib in the treatment of stageⅢunresectable small cell lung cancer.The clinical efficacy of apatinib in the treatment of stage Ⅲ unresectable NSCLC provides more choices and clinical evidence for the clinical treatment and prognosis of patients with advanced non-small cell lung cancer.MethodsNinety patients with stage Ⅲ NSCLC admitted to the First Affiliated Hospital of Zhengzhou University from January 2016 to January 2018 were selected and divided into observation group and control group with 45 cases each according to the treatment plan.The control group received radiotherapy combined with etoposide and cisplatin chemotherapy.All radiotherapy was performed using Intensity Modulated Radiation Therapy(IMRT),conventional split radiotherapy,PTV 60 Gy(2 Gy×30 times);Cisplatin,50 mg/m2,once a day,medication on days 1,8,29,and 36,etoposide 50 mg/m2,once a day,on days 1 to 5,29 to 33 Medications were given intravenously every 28 days.In the observation group,apatinib was administered orally on the basis of simultaneous chemoradiotherapy in the control group,0.25 g each time,once a day.Statistical methods were used to observe the differences in short-term and long-term effects and adverse reactions between the two groups.Analysis of adverse reactions:Observe bone marrow suppression,gastrointestinal reactions,radiation pneumonia,radiation esophagitis,hypertension,and hand,foot and skin reactions in the two groups of patients,and calculate the adverse reactions according to the common terminology of adverse events(grades 1 to 4).The short-term efficacy analysis was evaluated 1 month after the end of radiotherapy,and was divided into complete response(CR),partial response(PR),stable disease(SD),and progressive disease(PD)according to the evaluation criteria for solid tumor efficacy(RECIST 1.1).In the long-term efficacy analysis,patients were observed for progression-free survival(PFS)and overall survival(OS).Statistical methods were performed using SPSS 21.0 statistical software for data processing.All statistical tests were performed using two-sided tests.The univariate relationship between general information,adverse reactions,and short-term efficacy was analyzed by χ2 test,Fisher exact test,and rank sum test.Kaplan-Meier method was used for survival analysis,and log-rank test was used for comparison between groups.P<0.05 was considered statistically significant.ResultsGeneral information:Comparison of general information such as age,gender,smoking history,pathological classification,KPS score,and clinical stage between the two groups,the P values were greater than 0.05,and the difference was not statistically significant.Adverse reactions:90 patients had different degrees of adverse reactions,which improved after symptomatic treatment,and there were no deaths caused by serious adverse reactions.The incidence of adverse reactions in the observation group:hypertension 44.44%,hand-foot skin reaction 28.89%,bone marrow suppression 91.11%,gastrointestinal reaction 46.67%,radiation pneumonitis 31.11%,radiation esophagitis 48.89%,and the incidence of adverse reactions in the control group:hypertension 11.11%,Hand and foot skin reaction 0,bone marrow suppression 73.33%,gastrointestinal reaction 35.56%,radiation pneumonitis 22.22%,radiation esophagitis 46.67%.The incidence of hypertension and hand-foot skin reactions in the observation group were higher than those in the control group,and the differences were statistically significant(both P<0.05).There was no significant difference in the incidence of bone marrow suppression,gastrointestinal reactions,radiation pneumonia,and radiation esophagitis between the two groups(all P>0.05).Short-term effects:45 patients in the observation group,5 patients with CR(11.11%),25 patients with PR(55.56%),13 patients with SD(28.89%),2 patients with PD(4.44%),45 patients in the control group,and 2 patients with CR(4.44%),PR in 22 cases(48.89%),SD in 18 cases(40.00%),and PD in 3 cases(6.67%).There was no significant difference in the short-term efficacy between the two groups(χ2=2.476,P＝0.478).Long-term efficacy:observation period 3 to 33 months.The median PFS in the observation group was 13.47 months(95%CI:5.76 to 21.17),and the median PFS in the control group was 10.00 months(95%CI:7.21 to 12.79).The difference was statistically significant(P＝0.044).Observation group median OS 26.60 months(95%CI:16.60 to 36.59),control group median OS 23.3 months(95%CI:12.63 to 34.04),observation group The median survival time was 3.3 months longer than that of the control group,and the difference was statistically significant(P＝0.047).Conclusions1.Apatinib combined with standard concurrent chemoradiotherapy is well tolerated and safe in patients with locally advanced NSCLC.2.Oral apatinib combined with standard concurrent chemoradiation can prolong the median PFS and OS of patients with locally advanced NSCLC,which provides new stratrgy for clinical treatment. |
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