胰腺癌根治术联合放疗后局部复发与放疗靶区剂量的关系  

Relationship between patterns of local recurrence and radiotherapy target dose after postoperative adjuvant radiotherapy for pancreatic cancer

作　　者：杨伟芳[1,2] 欧阳玉秀 李婷婷[4] 王学全 侯利桥 吴莉莉 Yang Weifang;Ouyang Yuxiu;Li Tingting;Wang Xuequan;Hou Liqiao;Wu Lili(Department of Radiation Oncology,Taizhou Hospital of Zhejiang Province,Linhai 317000,China;Key Laboratory of Minimally Invasive Techniques&Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province,Linhai 317000,China;Department of Abdominal Tumor Radiotherapy,Guangdong Province Zhongshan City People's Hospital,Zhongshan 528400,China;Department of Radiation Oncology,Zhongshan Hospital Fudan University,Shanghai 200032,China)

机构地区：[1]浙江省台州医院放疗科,临海317000 [2]浙江省消化系肿瘤微创诊治与快速康复研究重点实验室,临海317000 [3]广东省中山市人民医院腹部肿瘤放疗科,中山528400 [4]复旦大学附属中山医院放疗科,上海200032

出　　处：《中华放射肿瘤学杂志》2022年第11期1011-1016,共6页Chinese Journal of Radiation Oncology

基　　金：浙江省医药卫生科技项目(2022KY1382);浙江省台州市科技计划项目(1901ky07)。

摘　　要：目的分析胰腺癌根治术联合辅助放疗后局部复发与放疗靶区剂量的关系,为辅助放疗提供靶区范围及处方剂量参考。方法回顾性分析2012—2020年接受根治术后行辅助放疗的T_(1‐4)N_(0‐2)M_(0)期胰腺导管腺癌患者138例,分析其局部复发的影响因素,以及局部复发部位与放射治疗靶区剂量的相关性。结果中位随访时间37.2个月,全组患者中位总生存(OS)期29.9个月,5年OS率为27.4%,中位无进展生存(PFS)期13.9个月,局部复发24例(17.4%),局部复发合并远处转移10例(7.2%)。其中可评估局部复发与放疗靶区剂量关系的共19例:首次局部复发位于腹主动脉旁、腹腔干旁和肠系膜上动脉旁的各有8、5和4例。单纯在PTV野内复发8例,其放疗剂量均在45 Gy以上。PTV野内、野外均复发8例,其中在剂量线40~52 Gy者3例,20~47.5 Gy者2例,0.5~52.5 Gy者3例。PTV野外者3例,均在剂量线0~20 Gy。结论胰腺导管腺癌根治术联合放疗后局部复发率较低。少部分患者发生放射野内高剂量范围内复发以及区域内野外复发,需探索更合适的靶区剂量及范围。Objective To retrospectively analyze the relationship between patterns of local recurrence and radiotherapy target dose after adjuvant radiotherapy for the pancreatic ductal adenocarcinoma(PDAC),aiming to provide reference for exploring reasonable target and dosage.Methods Clinical data of 138 patients with T_(1‐4)N_(0‐2)M_(0) PDAC who underwent adjuvant radiotherapy after radical resection from April 2012 to December 2020 were analyzed retrospectively.The influencing factors of local recurrence and the correlation between local recurrence site and radiotherapy target dose were analyzed.Results The median follow-up time was 37.2 months.The median overall survival(mOS)was 29.9 months.The 5-year OS rate was 27.4%.And the median progression-free survival(mPFS)was 13.9 months.There were 24 cases of local recurrence(17.4%),and 10 cases of local recurrence complicated with distant metastasis(7.2%).The correlation between local recurrence site and radiotherapy target dose could be evaluated in 19 patients with complete clinical data.The first local recurrence occurred near the para-aortic(Ao),the celiac axis(CA)and the superior mesenteric artery(SMA)were 8,5 and 4 cases,respectively.The radiotherapy doses of 8 patients with local recurrence only in the PTV field were above 45 Gy.There were 8 cases of local recurrence both in and out of the PTV field,including 3 cases with dose line between 40 and 52 Gy,2 cases with dose line between 20 and 47.5 Gy,and 3 cases with dose line between 0.5 and 52.5 Gy.There were 3 cases of local recurrence out of the PTV field,and the dose line ranged from 0 to 20 Gy.Conclusions The local recurrence rate of PDAC after radical surgery combined with postoperative radiotherapy is low,but a small number of patients have recurrence in the high-dose range of radiation field and regional recurrence out of the field.For these patients,it may be necessary to explore a more appropriate target dose and range for adjuvant radiotherapy.

关 键 词：胰腺肿瘤 放射疗法 局部复发 放疗剂量 

分 类 号：R735.9[医药卫生—肿瘤]