摘要
目的评价内镜下瘤体内注射重组人p53腺病毒治疗中晚期胃癌和食管癌的临床疗效及应用价值。方法对25例中晚期胃癌和食管癌患者行内镜下瘤体内注射重组人p53腺病毒(rAd-p53),剂量为1×1012VP/次或2×1012VP/次,每周1次,4次1个疗程,治疗后选择完成1个疗程及以上,并符合基因治疗入选标准者25例。通过临床观察、胃镜检查、病理对照及短期随访(6个月~1年)评估其疗效。结果治疗后2~3个月,复查胃镜提示9例患者肿块不同程度的缩小(36%),其中4例患者肿块缩小程度大于50%;无变化11例(44%),增大5例(20%)。25例患者均行组织病理学检查,16例可见肿瘤组织内大量的坏死物,炎性肉芽肿形成。20例病理标本进一步行免疫组化结果提示,15例标本中血管内皮生长因子(VEGF)的表达较治疗前下降。大部分患者病情稳定,症状好转,一般状况改善。除自限性发热外,未见出血等明显毒副反应。结论内镜下瘤体内注射rAd-p53治疗中晚期胃癌和食管癌不仅能控制基因治疗的靶向性,又能对基因药物疗效进行客观的评估,能较好地抑制局部肿瘤的发展,无明显毒副作用,是一种有前景的姑息性治疗手段。
Objective To investigate the therapeutic effect of endoscopic rAd-p53 injection in the treatment of advanced gastric carcinoma and esophageal carcinoma.Methods 25 patients with gastric and esophageal carcinoma were subjected to endoscopy-guided intratumoral injection of rAd-p53 at 1×1012 VP or 2×1012 VP once a week,4 times each course of treatment.25 patients who met the inclusion criteria for gene therapy and received one or two course(s)of treatment were enrolled.Clinical observation,endoscopy,pathology and short-time follow-up were used for the assessment of the clinical efficacy.Results Endoscopy showed that the tumor size in 9 cases(36%)was decreased in disparity degrees after 2~3 months,especially in 4 patients,whose tumors size decreased by more than 50%.In addition,there were 11 cases whose tumor didn't change(44%),and 5 cases increased(20%).Pathological biopsy showed that there were 16 cases carcinoma necrosis and carcinoma cells decreased.Immunohistochemisty showed that 15 cases VEGF expression were lower in 20 cases.Most of patients were no adverse responses except self-limited.Conclusion Endoscopy-guided injection of rAd-p53 could not only control the target of gene therapy for advanced gastric carcinoma and esophageal carcinoma,but also facilitate evaluating the clinical efficacy.It can restrain the progression of partial tumor,and there was no obvious adverse responses.It was a feasible and effective therapeutic method for those advanced patients.
出处
《宁夏医科大学学报》
2012年第11期1136-1139,F0004,共5页
Journal of Ningxia Medical University
基金
宁夏科技攻关项目
关键词
胃癌
食管癌
基因治疗
内镜引导
重组人P53腺病毒
gastric carcinoma
esophageal carcinoma
gene therapy
endoscopy-guided
recombinant adenovirus p53
