移动式直线加速器术中放射治疗进展期胰腺癌  

Intraoperative radiotherapy using a mobile linear acceletator for locally advanced pancreatic cancer

作　　者：程东峰[1] 李鸿哲[1] 赵胜光[2] 陈皓[1] 邓侠兴[1] 方圆[1] 沈柏用[1] 彭承宏[1] 李宏为[1] 陈佳艺[2] 

机构地区：[1]上海交通大学医学院附属瑞金医院胰腺中心,200025 [2]上海交通大学医学院附属瑞金医院放疗科

出　　处：《中华肝胆外科杂志》2016年第3期155-158,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的总结分析移动式直线加速器（Mobetron）术中放疗（IORT）对进展期胰腺癌的疗效。方法回顾性总结本中心2012年3月至2015年5月接受术中放射治疗的54例进展期胰腺癌患者的临床资料。其中可切除胰腺癌23例，不可切除胰腺癌31例（术中放疗组），并与同期未行术中放疗的不可切除胰腺癌63例进行对比分析（对照组）。结果54例IORT术后有7例发生B级胰漏，无放射性肠炎、出血等严重并发症。术中放疗组术后引流量较对照组明显增多（P〈0．05），两组术后胰漏发生率无统计学意义（P〉0．05）。术中放疗组的疼痛缓解率明显好于对照组（P〈0．05）。对照组术后CAl9-9血清值持续性增高，而术中放疗组的CAl99血清值在术后3～4个月呈下降趋势，4—5个月后又缓慢升高。23例可切除胰腺癌中健在22例，不可切除胰腺癌的中位生存期为8．8个月，明显长于对照组的4．8个月（P〈0．05）。结论移动式Mobetron对进展期胰腺癌开展术中放疗是安全、可行和便利的。该法近期疗效明显，有助于缓解腰背部疼痛、改善生活质量，并能延长胰腺癌患者的生存期，可推荐作为进展期胰腺癌综合治疗的重要方法之一。Objective To summarized and analyze the therapeutic efficacy of intraoperative radio- therapy （IORT） using a mobile linear accelatator （Mobetron） in treating locally advanced pancreatic can- cer. Methods The clinical data on 117 patients with locally advanced pancreatic cancer seen in our pan- creatic center from March 2012 to May 2015 were collected. 54 patients accepted IORT, including 23 patients with resectable pancreatic cancer and 31 patients with unresectable pancreatic cancer. The remaining 63 patients with unresectable pancreatic cancer did not undergo any surgery or radiotherapy. Results There were 7 patients with postoperative Class B pancreatic leakage, but no serious complications such as radioac- tivity enteritis and bleeding were observed. The postoperative drainage volume in the IORT group was signifi- cantly increased when compared with the control group （P 〈 0. 01 ）, but the incidences of postoperative pan- creatic leakage and other complications between the two groups showed no significant difference （P 〉 0. 05 ）. The rate of pain relief in the IORT group was significantly higher than that in the control group （P 〈 0. O1 ）. The serum CA199 level in the control group showed a sustained increase, which in the IORT group it initially decreased in the first 3 ~ 4 months after surgery but then increased slowly after 4 - 5 months. 22 patients with of 23 resectable pancreatic cancers in the IORT group were still alive. The median survival for unresect- able pancreatic cancer in the IORT group was 8.8 months, which was significantly longer than the 4. 8 months in the control group （ P 〈 0. 01 ）. Conclusions IORT with mobile Mobetron for advanced pancreatic cancer was safe, feasible and convenient. This approach significantly relieved back pain, improved quality of life and prolonged survival. IORT can be recommended to be an important part of comprehensive treatment for advanced pancreatic cancer.

关 键 词：胰腺癌 术中放疗 并发症 预后 

分 类 号：R735.9[医药卫生—肿瘤]