常规分割立体定向适形放射治疗晚期胰腺癌28例临床观察

Conventional Fraction Stereotactic Conformal Radiotherapy for Advanced Pancreatic Carcinoma

目的:探讨常规分割立体定向适形放射治疗晚期胰腺癌的临床效果。方法:对28例晚期胰腺癌患者进行了6MV-X线的常规分割立体定向适形放射治疗。利用体部立体定向框架及真空垫固定体位,CT扫描后输入到治疗计划系统中,根据肿瘤靶区、敏感器官和移动误差勾画GTV、CTV、和PTV,结合剂量-体积直方图选择最佳治疗方案,应用5～7个非共面野照射,80%～90%等剂量线包绕PTV,并以此为处方线,常规分割,每周5次,每次2Gy,总DT:60Gy～70Gy/42天～49天。结果:治疗后1～3个月,85.7%患者食欲改善,6例黄疸患者全部退黄,腹痛缓解者占60.7%,腹痛消失者占28.6%,肿瘤全消者占35.7%,肿瘤部分消失者占64.3%。1年生存率为76.5%(13/17),4例死于恶病质。结论:常规分割立体定向适形放射治疗能使晚期胰腺癌患者症状减轻,提高生活质量和延长生存期,尤其对年老体弱患者更宜选择该法治疗。

Objective: To seek an effective treatment of conventional fraction stereotactic conformal radiotherapy (C F S C R) for advanced pancreatic carcinoma. Methods: patients were treated by CFSCR of 6MVX-ray. Patients were fixed with vac-lok cushion of the device of stereotactic localization. the CT Scanning results of 28 cases of advanced pancreatic carcinoma were put into the treatment planning system. According to the target area of tumor, sensitive organs and moving error drew GTV, CTV and PTV. The best plan was selected in considering the dose-volume histogram. Using 5 to 7 beams of non-coplanar radiation ray were choosed. PTV were surrounded by 80%-90% isodose surves. Conventional fraction, 5 fractions per week, 2 GY per fraction, All patients received a total dose of 60 GY- 70GY /42-49 days. Results: In a period of one month to three months, after CFSCR, appetite was improved in 24 of 28 patients (85.7%), jaundice disappeared in 6 of 6 patients(100%), Abdominal pain was relieved in 17 of 28 patients (60.7%) and 8 patients were relieved completely (28.6%). the complete remission of tumor was 35.7% (10/28) and partial remission of tumor was 64.3% (18/28). One-year rate was 76.5%(13/17). As a consequence of cachexia, 4 patients died within 1 year. Conclusion: CFSCR for advanced pancreatic carcinoma may relieve symptoms. It is an effective approach to improve life quality and prolong survival time for advanced pancreatic carcinoma, especially lod and weak patients more suit to select CFSCR.