恩度联合同步放化疗治疗局部晚期宫颈癌的安全性及经直肠超声造影评估其抗血管生成作用
The safety of combining Endostar with concurrent chemoradiotherapy for the treatment of locally advanced cervical cancer and the evaluation of its anti-angiogenic effects via transrectal contrast-enhanced ultrasound.
作者信息
Wu Fang, Lu Zhouxue, Que Jinting, Ma Shanshan, Jiang Li, Tang Xiaobi, Zheng Chengshan, Zhou Li, Huang Qiufeng, Zhang Yong
机构信息
Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Guangxi Medical University, Ministry of Education, Nanning, Guangxi, China.
出版信息
Front Oncol. 2025 May 8;15:1514425. doi: 10.3389/fonc.2025.1514425. eCollection 2025.
BACKGROUND
In recent years, exploring the addition of angiogenesis inhibitors to chemoradiotherapy for locally advanced cervical cancer (LACC) has gained research interest. This study assessed the safety and anti-angiogenic effects of combining Endostar with concurrent chemoradiotherapy (CCRT) via transrectal contrast-enhanced ultrasound.
METHODS
A total of 120 patients with locally advanced cervical cancer (LACC) were randomly allocated to two groups: CCRT combined with Endostar (CRT+E group, n = 60) and CCRT alone (CRT group, n = 60). Endostar was administered intravenously before radiotherapy and repeated for four cycles. All patients received platinum-based CCRT. Adverse events were monitored, and transrectal contrast-enhanced ultrasonography (CEUS) was conducted before, during, and after radiotherapy. Vascular malformation (VM) rates were calculated from tumor cross-sectional images, and quantitative analysis software measured peak intensity (PI), time to peak (TTP), and mean transit time (MTT) of tumor vessels.
RESULTS
No significant differences were observed in hematological, hepatic, renal, gastrointestinal, or cardiac adverse reactions between the two groups (all P>0.05). In the CRT+E group, VM rates, TTP, and MTT significantly differed at three time points (with P values of 0.003, 0.002, and P<0.001, respectively), whereas the CRT group showed no significant changes (all P>0.05). Post-radiotherapy, statistically significant differences emerged between the CRT+E and CRT groups for VM rates (P = 0.027), MTT (P = 0.027), and TTP (P < 0.001), while PI showed no significant difference (65.67 ± 36.53 vs. 74.69 ± 61.21, P = 0.598).
CONCLUSION
The combination of Endostar with CCRT for locally advanced cervical cancer (LACC) demonstrated favorable safety and tolerability. Transrectal contrast-enhanced ultrasound (CEUS) effectively assessed tumor vascular normalization induced by Endostar during CCRT. Specifically, Endostar significantly reduced VM rates and shortened MTT, suggesting its potential to normalize tumor vasculature.
背景
近年来，探索在局部晚期宫颈癌（LACC）的放化疗中加入血管生成抑制剂已引起研究兴趣。本研究通过经直肠对比增强超声评估恩度联合同步放化疗（CCRT）的安全性和抗血管生成作用。
方法
总共120例局部晚期宫颈癌（LACC）患者被随机分为两组：CCRT联合恩度组（CRT+E组，n = 60）和单纯CCRT组（CRT组，n = 60）。在放疗前静脉注射恩度，并重复四个周期。所有患者均接受铂类同步放化疗。监测不良事件，并在放疗前、放疗期间和放疗后进行经直肠对比增强超声检查（CEUS）。根据肿瘤横断面图像计算血管畸形（VM）率，并用定量分析软件测量肿瘤血管的峰值强度（PI）、达峰时间（TTP）和平均通过时间（MTT）。
结果
两组在血液学、肝脏、肾脏、胃肠道或心脏不良反应方面均未观察到显著差异（所有P>0.05）。在CRT+E组，VM率、TTP和MTT在三个时间点有显著差异（P值分别为0.003、0.002和P<0.001），而CRT组无显著变化（所有P>0.05）。放疗后，CRT+E组和CRT组在VM率（P = 0.027）、MTT（P = 0.027）和TTP（P < 0.001）方面出现统计学显著差异，而PI无显著差异（65.67±36.53 vs. 74.69±61.21，P = 0.598）。
结论
恩度联合CCRT治疗局部晚期宫颈癌（LACC）显示出良好的安全性和耐受性。经直肠对比增强超声（CEUS）有效评估了CCRT期间恩度诱导的肿瘤血管正常化。具体而言，恩度显著降低了VM率并缩短了MTT，表明其具有使肿瘤血管正常化的潜力。
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