后程加量三维适形放疗同步化疗治疗局部晚期胰腺癌的疗效观察  

Prognosis Efficacy Analysis of Three-dimensional Conformal Radiotherapy with Increasing Dose in Late Course Combined with Chemotherapy in Patients with Locally Advanced Pancreatic Cancer

作　　者：李建军[1] 顾菲[1] 李光[1] 乔俏[1] 

机构地区：[1]中国医科大学附属第一医院放疗科,沈阳110001

出　　处：《中国医科大学学报》2013年第12期1113-1116,1121,共5页Journal of China Medical University

基　　金：辽宁省教育厅高校科研计划(L2010627)

摘　　要：目的观察后程加量三维适形放射治疗联合吉西他滨或卡培他滨化疗的，临床疗效。方法采用后程加量三维适形放射治疗同步吉西他滨、卡培他滨化疗或序贯化疗治疗54例局部晚期胰腺癌患者。观察患者的疼痛缓解率、血清CA19．9水平改变及近、远期疗效。结果后程加量三维适形放疗后胰腺癌患者疼痛缓解率为79．3％（32／42）；CA19—9平均值从治疗前的（361．4±107．5）U／mL下降到治疗后的（71．3±40．4）U／mL，差异有统计学意义（P〈0．01）。54例患者中完全缓解2例（3．70％），部分缓解19例（35．2％），疾病稳定28例（51．9％），疾病进展3例（5．56％），有效率为38．9％。胰腺癌放疗后1、2年生存率分别为63．0％、25．9％。吉西他滨同步放化组、卡培他滨同步放化组和放疗后序贯化疗组1、2年生存率分别为68．2％、76．5％、40．0％和31．8％、29．4％和13．3％。主要不良反应表现为1～2级的血液系统毒性和胃肠道反应，3～4级不良反应较少，且多发生在吉西他滨同步放化组，能为大多数患者所耐受。结论后程加量三维适形放疗同步吉西他滨或卡培他滨化疗治疗局部晚期胰腺癌疗效较好，能明显提高患者的生活质量并可能延长生存期，不良反应能为大多数患者耐受，是治疗局部晚期胰腺癌的较好方法。Objective To evaluate the acute side effects and efficacy of three- dimensional conformal radiotherapy with increasing dose in late course combined with chemotherapy for locally advanced pancreatic cancer treatment. Methods From Jan. 2006 to Jun. 2010,54 patients with lo- cally advanced pancreatic cancers were treated with three dimensional conformal radiotherapy with increasing dose in late course combined with cbe- mothempy. Pain relief, serum CA19-9 level change and survival rate of these pancreatic cancer patients were observed. Results After the treat- ment, remission rate of pancreatic cancer patients was 79.3%, avverage serum CA 19-9 level significantly dropped from 361.4±107.5 U/mL before treatment to 71.3 ±40.4 U/mL （ P 〈 0.01 ）. The overall response rate （ CR ＋ PR）, complete response rate （ CR）, partial response rate （ PR ） were 38.9 %, 3.70 %, and 35.2 %, respectively. 1 -year and 2-year survival rates were 63.0 % and 25.9 %, respectively. 1-year and 2-year survival rates of radiationtberapy with concurrent gemcitabine chemotherapy, radiationtherapy with concurrent capecitabine chemotherapy and sequential chemo- therapy after radiotherapy were 68.2%, 76.5%, 40.0 % and 31.8 %, 29.4%, 13.3 %, respectively. Grade 1/2 adverse events were more frequent in this study. Grade 3/4 hematologic toxicity and gastrointestinal reactions were much lower. Patients on therapy for mdiationtherapy combined with con- current gemcitabine chemotherapy had more Grade 3/4 events but could be tolerated by the majority of patients. Conclusion Three dimensional conformal radiotherapy with increasing dose in late course combined with chemotherapy is generally effective and well tolerated, which can signifi- candy improve the life quality and the survival rate in locally advanced pancreatic cancer patients.

关 键 词：胰腺癌 三维适形放射治疗 化学疗法 预后 

分 类 号：R735.9[医药卫生—肿瘤] R730.55[医药卫生—临床医学]