腹腔内贝伐珠单抗联合腹腔热灌注化疗治疗卵巢癌腹腔积液的临床观察

目的 观察腹腔内贝伐珠单抗联合腹腔热灌注化疗治疗卵巢癌腹腔积液的疗效和安全性，分析腹水内血管内皮生长因子（VEGF）水平对贝伐珠单抗治疗卵巢癌腹腔积液的临床意义。方法 将46例卵巢癌伴腹腔积液患者随机分为治疗组（n=25）和对照组（n=21），均应用TC方案（紫杉醇135mg／m2静脉注射d1+卡铂 AUC=5 静脉注射d1）全身化疗，3周重复1次；同时腹腔内给予顺铂40mg／m2+43～45℃ 0.9%生理盐水1500～3000ml热灌注化疗，每2周重复1次，连续治疗6周。治疗组在上述治疗基础上每次热灌注化疗后腹腔内注入贝伐珠单抗300mg，治疗6周。评价患者疗效、生活质量改善及不良反应。酶联免疫吸附法（ELISA）检测46例患者治疗前、后腹水中VEGF水平。结果 治疗组治疗后腹水VEGF水平为（468.30±42.80）pg/ml，明显低于治疗前的（2785.89±305.22）pg/ml（P＜0.05）；治疗组治疗后腹水VEGF水平明显低于对照组治疗后的（820.20±61.49）pg/ml（P＜0.05）。治疗组的有效率（RR）为92.0％（23／25），对照组为61.9％（13／21），差异有统计学意义（P＜0.05）。治疗组中VEGF阳性者的RR达1000％，VEGF阴性者为50.0％，差异有统计学意义（P＜0.05）。治疗组的生活质量（QOL）改善率为92.0％，对照组为57.1％，差异有统计学意义（P＜0.05）。46例患者对治疗的耐受良好，无严重不良反应。结论 腹腔内贝伐珠单抗联合腹腔热灌注化疗治疗卵巢癌腹腔积液的疗效优于单纯腹腔热灌注化疗，生活质量明显改善，安全性好，尤其对于腹水VEGF阳性卵巢癌患者更加适合。

Clinical study in treatment of malignant ascites of ovarian cancer with intraperitoneal injection bevacizumab combined with intraperitoneal hyperthermic perfusion chemotherapy

Objective To study the efficacy and safety of intraperitoneal injection bevacizumab combined with intraperitoneal hyperthermic perfusion chemotherapy in treatment of malignant ascites of ovarian cancer. To analyze the clinical significance of the con- centration change of vascular endothelial growth factor（VEGF） in ascites in treatment of intraperitoneal injection bevacizumab. Meth- ods Forty-six patients with malignant ascites of ovarian cancer were randomly divided into treatment group （ n = 25 ） and control group （n = 21 ）. All patients were treated with TC chemotherapy（ paclitaxel 135mg/m2 ,iv d1 ＋ carboplatin AUC =5, iv dI ） , repeated every 3 weeks for 6 weeks, and with intraperitoneal hyperthermie perfusion chemotherapy combined with intraperitoneal cisplatin 40mg/m2 , repeated every 2 weeks for 6 weeks. The treatment group were accepted intraperitoneal injection with bevacizumab（avastin） 300mg af- ter each intraperitoneal hyperthermic perfusion chemotherapy for 6 weeks. The improvement of life quality, curative effect and adverse reaction were evaluated. The concentration of VEGF of ascites of two groups were assayed by ELISA method before and after treatment. Results After treatment, the concentration of VEGF in ascites of treatment group was（468.30 _＋ 42. 80）pg/ml, which was lower than that of treatment group before treatment（ P 〈 0. 05 ） , which was decreased significantly compared with that of control group（ P 〈 0. 05 ）. The total effective rate of the treatment group was 92. 0%, which was higher than 61.9% of the control group. There were significant differences in two groups（P 〈 0. 05）. In the treatment group, the effective rate in VEGF-positive patients was 100. 0% , and it was 50. 0% in VEGF-negative patients（P 〈0.05）. The improvement rate of quality of life（QOL） was 92.0% in treatment group, while it was 57. 1% in control group, which had significant difference between two groups（P 〈0. 05）. ／11 Ihe patients were of good tolerance in whole therapy and no severe side effects occured. Conclusion The treatment of malignant as~＇it,＇s of ovarian cancer with intraperito- neal injection bevacizumab combined with intraperitoneal hyperthermic perfusion chemotherapy is effective and safety, especially to VEGF-positive patients with ovarian cancer ascites.