不同定位方式放疗联合化疗治疗胰腺癌的疗效和预后分析  

Result and prognostic analysis of radiotherapy in different ways and concurrent chemotherapy for pancreatic carcinoma

作　　者：任宝志[1] 周玉霞[1] 幸泽鲜[1] 张红[1] 陶星[2] 

机构地区：[1]德阳市人民医院肿瘤科,四川德阳618000 [2]上海交通大学医学院苏州九龙医院核医学科PET/CT室,江苏苏州215021

出　　处：《现代肿瘤医学》2014年第4期872-875,共4页Journal of Modern Oncology

摘　　要：目的:比较各期胰腺癌普通X线模拟定位、CT定位以及PET/CT定位三维适形放疗(3DCRT)协同化疗的疗效、不良反应和预后。方法:回顾性分析12年间各期胰腺癌患者共136例,分别接受普通X线模拟定位(普放组)、CT定位(普通CT组)和PET/CT定位(PET/CT组)放疗。各组放疗中、放疗后均配合口服卡莫氟治疗或以铂类为基础联合氟尿嘧啶类或紫杉醇类等化疗4-6周期(21-28d为1周期)。随访并比较各种治疗方法的疗效、不良反应和预后。结果:PET/CT组的平均GTV和PTV体积,以及胃、肝、左肾、右肾、脊髓平均照射体积均比普通CT组小,两者差异均有显著统计学意义(P均<0.05)。PET/CT组与普通CT组早期胃肠道反应均低于普放组(P均<0.05)。普放组死于原发灶未控、复发的比例高(P均<0.05)。多因素分析表明,T分期和治疗前GTV是独立的预后因子(P<0.01)。结论:PET/CT定位及三维适形放疗治疗胰腺癌可以优化放疗计划,减轻胃肠道的早期放射不良反应,分期早的病变预后好。Objective： To analyse the result of radiotherapy by ordinary X - based simulation, CT simulation, PET/ CT positioning three -dimensional eonformal radiotherapy（3DCRT） and concurrent chemotherapy for pancreatic car- cinoma. Methods：To review 136 patients with pancreatic carcinoma by ordinary X ray simulator（ normal group） , CT localization （ normal CT group） and PET/CT localization （ PET/CT group） radiotherapy. All patients were treated by oral Carmofur or platinum - based joint - paclitaxel or fluorouracil for 4 -6 cycles of concurrent chemotherapy（21 - 28d for 1 cycle）. Follow- up and compare the efficacy of various treatments, side effects and prognosis. Results：The average GTV and PTV＇s volume, and the average irradiated volume of stomach, liver, left kidney, right kidney and spinal cord of the PET/CT group were smaller than that of the normal CT group, there was statistically significant difference（all P 〈0.05） between the two groups. The early gastrointestinal＇s 1,2- grade adverse reactions of the PET/CT group and normal CT group were lower than that of normal group（P 〈0.05 ）. Cases died of uncontrolled pri- mary tumor and recurrence of the normal group were higher than that of others （ all P 〈 0.05 ）. Multivariate analysis showed that the patients with early T stage lesions and small GTV were better than that of others（ all P 〈0.01 ）. Con- clusion：PET/CT positioning 3DCRT can optimize the radiation treatment planning,reduce the early radiation gastro- intestinal side - effects, patients with early stage lesions have better prognosis.

关 键 词：胰腺肿瘤 放射疗法 化学疗法 正电子断层显像 三维适形放射治疗 预后 

分 类 号：R735.9[医药卫生—肿瘤]