不同方法治疗晚期胰腺癌的临床疗效观察  

Effects of 3D - CRT combined with chemotherapy and chemotherapy alone in advanced pancneatic cancer

作　　者：栾瑾微[1] 尤庆山[1] 

机构地区：[1]哈尔滨医科大学附属肿瘤医院放疗三科,哈尔滨150081

出　　处：《实用肿瘤学杂志》2009年第4期328-331,共4页Practical Oncology Journal

摘　　要：目的观察三维适形放疗（3D—CRT）联合化疗与单纯化疗治疗晚期胰腺癌的临床疗效和毒副反应。方法我院2000年1月-2006年6月收治的40例晚期不能手术切除的胰腺癌患者。三维适形放疗（3D—CRT）与FH方案交替化疗8例，三维适形放疗联合GP方案化疗12例，单纯GP方案化疗20例。三维适形放疗技术应用CT模拟机定位，3D—TPS进行放射治疗计划设计，90％等剂量归-1．8Gy-1．9Gy／次，1次／日，5次／周，放射剂量50．4Gy-62．7Gy／5．5—7周。GP方案：健择700mg／m^2-1000mg／m^2，d1，8，顺铂20mg／m^2，d1-3，单纯化疗组28天为1周期，连用2—5周期；放化组在放疗前后各1周期。FH方案：5-Fu500mg／m^2，HCPT10mg／m^2，第1—5天和第33—38天各1周期，每次化疗结束后即开始放疗。结果GP方案单纯化疗组35％出现Ⅲ、Ⅳ级血液毒性，放疗＋GP组25％，放疗＋FH组12．5％。放化组疼痛缓解率55％，放疗＋GP组50％，放疗＋FH组62％，单纯化疗组20％。放化组有效率30％，放疗＋GP组25％，放疗＋FH组37％，单纯化疗组5％。放化组中位生存期12．0个月，放疗＋FH组12．5个月，单纯化疗组7个月。放化组1年生存率50％，放疗＋FH组62％，放疗＋GP组41％，GP方案单纯化疗组20％。结论三维适形放疗联合化疗的疼痛缓解率，有效率高于单纯化疗。三维适形放疗联合化疗较单纯化疗提高了中位生存期和1年生存率，并且副反应低。放疗＋FH方案交替在疼痛的缓解率、有效率、生存期和副反应方面有优于放疗＋GP方案的趋势。Objective To observe the effects and toxicities of the patients with advanced pancreatic cancer treated with 3D - CRT combined with chemotherapy or chemotherapy alone. Methods 40 patients with advanced pancreatic cancer from January,2000 to June,2006 were divided into three groups：chemotherapy alone group（20 patients）3D- CRT with FH group（8 patients） 3D -CRT with GP group（ 12 patients）. Three dimensional conformal radiotherapy（3D- CRT） carried out as following： CT simulation localization,3D- TPS, time/ fraction schedule ： 1.8 - 1.9 Gy/F to the 90% isodose line, 1 F/D, 5 F/W, overall rate： 50.4 - 62.7 Gy. Chemotherapy：GP scheme：gemcitabine 700 - 1000/m^2 d1,8 and Cisplatin 20 mg,/m^2d1 - 3, GP scheme was applied one cycle at every four weeks and two to five cycles in chemotherapy alone group, and one cycle before and after radiation in 3 D - CRT with GP group;FH scheme ：5 - Fu 500 mg/m^2 and Hcpt 10 mg/m^2 delivered respectively in five days continually, then radiated, when dose achieved 40 Gy, the other cycle was given immediately, then radiated again. Results The side effect of 3D - CRT with chemotherapy group was slighter than that of chemotherapy alone group, especially in the FTI group. The rate of pain palliation of them were 55% and 20% respectively（ P 〈 0. 05）and is higher in the FH group（62% ）. Five patients experienced partial response and one complete response in the 3D - CRT with chemotherapy group,but partial response was observed in only one patient of the chemotherapy alone group（P 〈0.05） ,and the better effect was observed in the FH group,though without a statistical difference. The median survival from the time of therapy was 12 months in 3D - CRT with chemotherapy group, higher than that of chemotherapy alane group（ P 〈 0. 05 ）. The survival rate of 1 year in the former was better, especially in the FH group （ P 〈 0.05 ）. Conclusion The rate of pain palliation was higher in 3 D - CRT with chemotherapy group than that of chemotherapy alone

关 键 词：胰腺癌 晚期 三维适形放疗 化疗 

分 类 号：R735.9[医药卫生—肿瘤]