摘要
目的观察立体定向放疗(体部伽玛刀)联合吉西他滨(GEM)治疗胰腺癌的疗效及安全性。方法将131例局部中晚期胰腺癌患者按不同治疗方案分为A、B两组,A组(82例)仅接受立体定向放疗,B组(49例)接受立体定向放疗联合GEM单药化疗。立体定向放疗以50%等剂量曲线覆盖100%计划靶区,60%等剂量曲线覆盖90%临床靶区,70%等剂量曲线覆盖80%肿瘤区。以50%等剂量曲线作为处方剂量,胰头部肿瘤3～4Gy/次,胰体尾部肿瘤4～5Gy/次,8～12次,计划靶区边缘总剂量32～50Gy。首程同步化疗,GEM 0.5g/m2静滴30min,放疗治疗开始第1、8天给药。放疗结束3周后开始序贯化疗,GEM 1g/m2,静滴30min,第1、8、15天给药,28天为1周期。共化疗2～6周期。中位随访时间17.0个月,观察疗效及毒副反应,随访总生存期和无进展生存期。结果 A、B两组客观有效率分别为71.9%、79.6%,止痛有效率分别为94.3%、93.3%,组间差异均无统计学意义(P>0.05)。治疗后A、B两组的总胆红素、CA199指标均较治疗前明显改善,差异均有统计学意义(P<0.01),但A、B两组之间差异均无统计学意义(P>0.05)。A、B两组中位生存时间分别为14.1、16.4个月,中位无进展生存时间分别为7.9、13.0个月。B组患者的消化道反应和骨髓抑制发生率较A组高,但能够耐受,其余毒副反应相近,均未见穿孔、大出血、持续高热以及4级骨髓抑制等严重并发症发生。结论立体定向放疗治疗中晚期胰腺癌能使肿瘤局部得到准确的高剂量照射,周围正常组织损伤小,疗效较好。联合GEM显著延长了无进展生存时间,但未能改善总生存时间,同时增加了部分毒副反应,但可耐受。
Objective To observe clinical therapeutic effect of stereotactic conformal radiotherapy（body gamma knife）combined with gemcitabine for patients with pancreatic carcinoma. Methods A total of 131 patients with advanced local pancreatic carcinoma were divided into two groups（group A,82 cases received radiotherapy alone;group B,49 cases got radiotherapy combined with gemcitabine）.All of them（male 95,female 36,aged 23-82 years old,median age 71.8 years old） were treated by OUR-QGD type stereotactic radiotherapy gamma rays system： 50% dose curve overjetted 100% plan target volume（PTV）,60% dose curve overjetted 90% clinical target volume（CTV）,70% dose curve overjetted 80% grosses tumor volume（GTV）.The prescription dose was according to 50% dose curve.Encircled dose of carcinoma which in the head of pancreas was 3-4Gy per fraction,in the body tail of the pancreas was 4-5Gy per fraction.The range of total dose was 32-50Gy,divided into 8-12 fractions.The concomitant chemotherapy started at the first day of radiotherapy： gemcitabine 0.5g/m^2 intravenously injected within 30 minutes,d1,d8.That adjuvant chemotherapy was taken 3 weeks after radiotherapy： gemcitabine 1g/m^2,VD,d1,d8,d15;28 days was a cycle.The chemotherapy lasted for 2-6 cycles continuously.The median time of follow-up was 17 months.Therapeutic effect,side effects,overall survival（OS） and progression-free survival（PFS） were recorded. Results In group A and B,the rate of the overall response（CR＋PR） was 71.9% and 79.6%,the rate of pain remitting in epigastria and notum was 94.3% and 93.3%,respectively（P〉0.05）.After treatment,the index of total bilirubin and CA199 were significantly improved in both two groups.The median PFS and OS between group A and B were 7.9 and 13.0 months,14.1 and 16.4 months,respectively.There were significant differences between group A and B in PFS（P〈0.05）,but not in OS.Rate of the major toxicities occurring of group B in gastrointestinal tract reaction and hematology was higher than group A.No perforation,serious bleeding or continuous high fever has been observed.No treatment-related death occurred. Conclusion The stereotactic conformal radiotherapy for patients with pancreatic carcinoma can increase accurately localized high-dose radiation on tumor,and reduce the surrounding normal tissue damage.Stereotactic conformal radiotherapy combined with gemcitabine can significantly prolong PFS,but fail to improve OS,while increase part of toxicity.
出处
《临床肿瘤学杂志》
CAS
2011年第11期995-1000,共6页
Chinese Clinical Oncology
关键词
胰腺肿瘤
立体定向放射治疗
化学治疗
疗效
Pancreatic carcinoma
Stereotactic conformal radiotherapy
Chemotherapy
Efficacy
