磁共振灌注成像在重组人血管内皮抑制素联合放化疗治疗局部晚期鼻咽癌中的临床研究

目的 比较鼻咽部磁共振灌注成像（PWI）参数的变化，评价血管内皮抑素联合放化疗的抗血管生成作用，评估其治疗疗效的早期反应。方法 前瞻性研究2011年12月30日至2013年3月31日，22例局部晚期鼻咽癌患者接受重组人血管内皮抑制素联合诱导化疗序贯同步放化疗治疗（试验组），选取诱导化疗序贯同步放化疗的25例局部晚期鼻咽癌患者入对照组。诱导化疗前后、同步放化疗后行鼻咽部灌注核磁共振扫描（PWI）得出相关参数血容量（BV）、血流量（BF）、平均通过时间（MTT）。结果 试验组中，在诱导化疗后及放疗后鼻咽部病灶区域的BV、BF值较诱导化疗前均有明显下降（F=3.05、3.85，P<0.05），MTT值差异无统计学意义（P>0.05）。对照组中，鼻咽部病灶区域相关参数BV、BF、MTT在治疗过程中的变化差异均无统计学意义（P>0.05）。试验组鼻咽部病灶区域的BF在放疗后下降明显低于对照组（0.72±0.56 vs 1.92±1.26，t=-3.056，P=0.012）。结论 血管内皮抑素在改变肿瘤血液动力学变化方面起到了一定的作用，其治疗相关性不良反应患者可以耐受。磁共振灌注成像有可能更早、更敏感地评估抗血管生成治疗减少肿瘤的疗效。临床试验注册号 中国临床试验注册中心，ChiCRT-ONRC-12002394.

A clinical study of perfusion weighted magnetic resonance imaging in recombinant human endostatin combined with chemotherapy and radiotherapy for locally advanced nasopharyngeal carcinoma

Objective To assess the antiangiogenic role of recombinant human endostatin combined with chemoradiotherapy and the capacity, and to explore the early tumor response as measured by comparing the change of MRI perfusion parameter.Methods From May 2012 to March 2013, 22 locally advanced nasopharyngeal carcinoma patients who received recombinant human endostatin combined with chemoradiotherapy following induction chemotherapy, were included in the prospective study group. The other 25 patients, who received chemoradiotherapy following induction chemotherapy alone in the same period, were included in the control group. The perfusion parameters including blood volume(BV), blood flux(BF), mean transit time(MTT) were obtained by carrying out MR perfusion scanning at 3 time points: before induction chemotherapy, after induction chemotherapy, the end of concurrent chemoradiotherapy.Results Compared with before induction chemotherapy, the perfusion parameters including BV and BF obviously decreased in the study group(F=3.05, 3.85, P<0.05). The parameter of MTT had no obviously change in the study group(P>0.05). In the control group, the change of BV, BF and MTT of nasopharyngeal lesions area during the treatment showed no significant difference(P>0.05). To make comparison between the two groups, at the end of concurrent chemoradiotherapy, BF of nasopharyngeal lesions area in the study group was 0.72±0.56 and 1.92±1.26 in the control group, the former showing significantly declined results(t=-3.056, P=0.012). Conclusions Recombinant human endostatin might be a good indicator of local tumor microvascular changes and the treatment-related toxicity could be tolerated. Magnetic resonance perfusion imaging maybe assessed the capacity of anti-angiogenesis therapy to induce early tumor response. Clinical trial registration Chinese clinical trial registry, ChiCRT-ONRC-12002394.