同步放化疗联合尼妥珠单抗治疗老年食管癌

Concurrent Radiation Therapy Combined with Nimotuzumab for Elderly Patients with Esophageal Cancer

摘要: 目的：评价同步放化疗联合尼妥珠单抗治疗老年局晚期食管癌的有效性和安全性。方法：收集2021年1月至2023年12月，两组患者年龄均70岁以上，而且不耐受含铂双药化疗及免疫治疗的老年局晚期食管癌鳞癌患者。采用单药替吉奥(S-1)口服化疗同步加量放疗，联合尼妥珠单抗治疗(联合组)34例，采用单药替吉奥口服化疗同步加量放疗(放化疗组) 40例。比较两组患者的临床疗效和不良反应，采用Kaplan-Meier法绘制无进展生存曲线，并进行Log-rank检验。结果：两组患者临床基线特征的差异无统计学意义(P > 0.05)；放化疗结束后随访3个月，统计两组的近期临床疗效，两组ORR有统计学差异(χ² = 5.299, P = 0.021)，DCR有统计学差异(χ² = 4.944, P = 0.026)，两组1年PFS率存在统计学差异(χ² = 10.252, P = 0.001)。联合组疗效优于放化疗组，未增加不良反应。结论：对于不耐受含铂双药及免疫治疗的患者，同步加量放疗联合S-1化疗及尼妥珠单抗治疗，也是70岁及以上食管鳞癌患者可选方案之一，安全性良好。

Abstract: Objective: To evaluate the efficacy and safety of synchronous radiotherapy and chemotherapy combined with Nimotuzumab in the treatment of advanced esophageal cancer in elderly patients. Method: From January 2021 to December 2023, we collected data on two groups of elderly patients, all aged over 70, who were intolerant to platinum-based doublet chemotherapy and immunotherapy. These patients had locally advanced esophageal squamous cell carcinoma. One group, consisting of 34 patients, received concurrent dose-escalated radiotherapy and oral single-agent S-1 chemotherapy combined with nimotuzumab (Combination Group). The other group, consisting of 40 patients, received concurrent dose-escalated radiotherapy and oral single-agent S-1 chemotherapy (Chemoradiotherapy Group). The clinical efficacy and adverse reactions of the two groups of patients were compared. Kaplan-Meier curves were used to plot the progression-free survival, and the Log-rank test was performed. Result: There was no statistically significant difference in clinical baseline characteristics between the two groups of patients (P > 0.05); After a 3-month follow-up after radiotherapy and chemotherapy, the recent clinical efficacy of the two groups was statistically analyzed. There was a significant difference in ORR between the two groups (χ² = 5.299, P = 0.021), DCR (χ² = 4.944, P = 0.026), and 1 year PFS rate between the two groups (χ² = 10.252, P = 0.001). The efficacy of the combination group is better than that of the chemoradiotherapy group, with no adverse reactions. Conclusion: For patients who are intolerant to platinum based dual therapy and immunotherapy, simultaneous dose radiotherapy combined with S-1 chemotherapy and Nimotuzumab treatment is also one of the options for esophageal squamous cell carcinoma patients in the age of 70 or above, with good safety.