γ-射线立体定向体部放射治疗局限期胰腺癌65例  

Efficacy and toxicity of γ-ray stereotactic body radiation therapy in management of locally advanced pancreatic carcinoma: Our experience with 65 cases

作　　者：康晓黎[1] 王颖杰[2] 邵银剑[2] 李宏奇[2] 李平[2] 王济东[2] 王轩[2] 夏廷毅[2] 

机构地区：[1]河北北方学院研究生院,河北省张家口市075000 [2]中国人民解放军空军总医院肿瘤放疗科,北京市100142

出　　处：《世界华人消化杂志》2013年第13期1266-1272,共7页World Chinese Journal of Digestology

基　　金：首都医学发展科研基金资助项目;No.2009-2057~~

摘　　要：目的:观察γ-射线立体定向体部放射治疗局限期胰腺癌的疗效和放射治疗反应,探讨影响其预后的相关因素.方法:这是一项前瞻性的临床研究,对符合入组条件的65例局限期胰腺癌患者给予γ-射线立体定向体部放射治疗.采用50%剂量线覆盖计划靶区(planning target volume,PTV),PTV边缘剂量3-5 Gy/次,5次/wk,总剂量45-51 Gy/2-3 wk的高分次剂量治疗模式.生存分析采用Kaplan-Meier法,多因素分析采用Cox比例风险回归模型,分析影响患者预后的相关因素.结果:全组患者原发灶完全缓解率23%、部分缓解率48%,总有效率为71%.1年总生存率为52.4%,中位生存期13 mo.放疗后急性消化系反应,1级为51%,2级为18%,未见3级不良反应.骨髓抑制1级为28%,2级为8%,经对症处理后患者均能按计划完成治疗.多因素分析结果显示TNM分期、治疗前CA199≥425.8 U/mL是胰腺癌患者独立预后因素.结论:γ-射线立体定向体部放射治疗局限期胰腺癌采用3-5 Gy/次,5次/wk,PTV边缘50%等剂量线处总剂量45-51 Gy的治疗模式是安全有效的,对局限期胰腺癌可获得较好的局控率和生存率,并可缓解疼痛,提高生活质量.其TNM分期、CA199水平可为胰腺癌的预后判定提供参考依据.AIM：To evaluate the efficacy and toxicity of γ-ray stereotactic body radiation therapy in the management of locally advanced pancreatic carcinoma,and to analyze factors affecting prognosis of locally advanced pancreatic carcinoma.METHODS：Sixty patients with locally advanced pancreatic carcinoma who were treated with the γ-ray stereotactic body radiation therapy in our department were prospectively enrolled.Depending on tumor size,a total dose of 45-51 Gy was delivered at 3-5 Gy/fraction over 2-3 wk in 5 fractions per week to the 50% isodose line covering the planning target volume.Survival and prognostic factors were analyzed using the Kaplan-Meier method and Cox proportional hazard model,respectively.Univariate and multivariate analyses were performed to examine factors affecting clinical outcome.RESULTS：Of all lesions,15（23%） completely disappeared,and 31（48%） had a partial response.The total response rate was 71%.The overall 1-year survival rate was 52.4% and the median survival time was 13 mo.All patients tolerated the treatment well and completed the planned therapy.Grade Ⅰ acute gastrointestinal toxicity developed in 33（51%） patients,and grade Ⅱ gastrointestinal toxicity was observed in 12（18%） patients.Eighteen（28%） patients were diagnosed with grade Ⅰ leukocytopenia,and 5（8%） patients had grade Ⅱ leukocytopenia.Multivariate analysis demonstrated that TNM stage and CA199 ≥ 425.8 U/mL were independent prognostic factors for pancreatic cancer.CONCLUSION：γ-ray stereotactic body radiation therapy can result in a good curative effect and local control in the treatment of locally advanced pancreatic cancer.No severe adverse events occurred.TNM stage and CA199 ≥ 425.8 U/mL are independent prognostic factors for locally advanced pancreatic carcinoma.

关 键 词：局限期胰腺癌 γ-射线 立体定向放射治疗 预后 

分 类 号：R735.9[医药卫生—肿瘤]