射波刀治疗局部晚期胰腺癌的临床疗效分析  

Clinical outcomes of CyberKnife radiosurgery treatment in locally advanced pancreatic cancer

作　　者：沈泽天[1] 武新虎[1] 李兵[1] 沈君姝[1] 高淑萍[1] 朱锡旭[1] 

机构地区：[1]南京军区南京总医院放疗科,江苏南京210002

出　　处：《中国癌症杂志》2012年第8期589-594,共6页China Oncology

基　　金：南京军区南京总医院青年基金课题资助项目(No:2009q051)

摘　　要：背景与目的:射波刀(CyberKnife)是一种肿瘤立体定向放射外科治疗(SRS/SRT)领域的新技术,具有同步呼吸追踪、实时影像引导、无框架定位及高精确度等优势,近年来已被应用在全身肿瘤的治疗上。本文回顾性分析射波刀立体定向放射治疗局部晚期胰腺癌的临床疗效及其不良反应。方法:2009年03月—2010年08月,接受射波刀治疗的局部晚期胰腺癌32例,年龄45～79岁,临床分期Ⅱ期12例,Ⅲ期20例;胰头癌19例,胰体尾癌13例。胰腺癌计划靶体积29～124 cm3,中位52 cm3,计划靶体积为肿瘤体积外放2～3 mm,分割3～6次,总剂量40～55 Gy,中位剂量45 Gy,72%等剂量面必须包括95%以上计划靶体积。32例患者全部采用肿瘤内植入金标的同步呼吸追踪技术(Synchrony),治疗后评估疗效和不良反应。结果:所有患者治疗耐受性良好,主要不良反应表现为乏力、恶心、呕吐。随访时间4～30个月(中位时间16个月),12例患者存活,CT复查结果完全缓解(CR)6例,部分缓解(PR)17例,稳定(SD)6例,进展(PR)2例,有效率(CR+PR)为74.2%,1年生存率为53.1%。无3级血液学毒性及4级非血液学毒性发生。结论:采用射波刀进行立体定向放射治疗局部晚期胰腺癌近期疗效显著,安全性好,远期疗效需进一步随访。Background and purpose： CybeKnife is a newly developed technology in the field of stereotactic radiosurgery/radiotherapy （SRS/SRT）. Compared with conventional SRS/SRT, there are many advantages for CyberKnife in terms of treating tumors that move with respiration, being real-time image-guidance, frameless, high accurateness, etc. Recently, it has been used to treat different types of malignant carcinoma including intracranial and caudomedial tumors. This study was designed to retrospectively analyze the efficacy and toxicity of the CyberKnife in the treatment of locally advanced pancreatic cancer. Methods： Thirty-two patients with locally advanced （stage II-III） pancreatic cancer treated with CyberKnife were recruited from Mar. 2009 to Aug. 2010. Of the 32 patients, 19 were pancreatic head cancer, 13 were pancreatic body and tail cancer. The PTV=GTV＋（2 or 3） mm, and the median volume of PTV was 52 cm3 （29-124 cm3）. The median total prescription dose was 45 Gy （40-55 Gy） at 3-6 fractions. More than 95% target volume was covered by 75% isodose surface. During treatment delivery, all the patients were implanted fiducials in the tumors to track movement of the tumor and patient breathing patterns. Results： The median follow-up time was 16 months （4-30 months）. All patients had finished the treatment and 12 were alive by the last follow- up. Slight fatigue was the most common side effect. Evaluated by CT scan, 6 were complete response, 17 were partial response, 6 were stable disease and 2 were progression. The overall response rate （CR＋PR） was 74.2%, and the 1-year survival rate was 53.1%. Neither grade 3 hematologic nor grade 4 non-hematologic toxicities were observed. Conclusion： The CyberKnife radiosurgery treatment in the locally advanced pancreatic cancer shows a high rate of local control and minimal toxicity. Long time follow-up is necessary to evaluate the survival data and late toxicity.

关 键 词：射波刀 局部晚期胰腺癌 临床疗效 

分 类 号：R735.9[医药卫生—肿瘤]