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目的探讨采用选择性动脉灌注,进行p53基因联合化疗冶疗晚期头颈癌的临床疗效及其安全性。方法将2003至2005年间收治的56名晚期口腔癌患者随机分为3组,通过选择性动脉灌注给予rAd-p53联合化疗(Ⅰ组),单纯rAd-p53基因治疗(Ⅱ组)及单纯化疗(Ⅲ组),评价各组疗效,并检测治疗前后wt-p53、Bax以及Bcl-2的蛋白表达水平。结果Ⅰ组的完全有效率、总体存活率明显高于Ⅱ、Ⅲ两组,但Ⅱ、Ⅲ两组的治疗结果并没有明显差异。最常见的副作用是暂时性流感样症状和骨髓抑制。与治疗前相比,Ⅰ、Ⅱ组患者治疗后wt-p53蛋白免疫活性升高,Bax免疫染色呈阳性,而Bcl-2降低。结论选择性动脉灌注可提高rAd-p53基因治疗疗效,rAd-p53基因治疗联合化疗可有效提高晚期口腔癌患者的生存率。
Objective To explore the clinical efficacy and safety of selective arterial infusion in the treatment of advanced head and neck cancer with p53 gene combined with chemotherapy. Methods Fifty-six patients with advanced oral cancer who were treated between 2003 and 2005 were randomly divided into three groups. Patients were given rAd-p53 combined with chemotherapy (group Ⅰ), simple rAd-p53 gene therapy (group Ⅱ) and chemotherapy alone Group Ⅲ). The curative effect of each group was evaluated. The protein expression of wt-p53, Bax and Bcl-2 were detected before and after treatment. Results The complete efficiency and overall survival rate of group Ⅰ were significantly higher than those of group Ⅱ and Ⅲ, but there was no significant difference between groups Ⅱ and Ⅲ. The most common side effects are transient flu-like symptoms and myelosuppression. Compared with those before treatment, the immunosuppressive activity of wt-p53 protein in group I and group II was increased, Bax immunostaining was positive, and Bcl-2 was decreased. Conclusions Selective arterial infusion can improve the therapeutic effect of rAd-p53 gene therapy. The combination of rAd-p53 gene therapy and chemotherapy can effectively improve the survival rate of patients with advanced oral cancer.