伽玛刀治疗晚期胰腺癌的临床研究

Clinical research in advanced pancreatic carcinoma with gamma rays

目的探讨立体定向放射治疗晚期胰腺癌的近期临床疗效.方法采用OUR-QGD型立体定向伽玛射线体部治疗系统(体部伽玛刀)治疗了31例晚期胰腺癌患者.伽玛刀治疗采用三维立体定向治疗计划系统给予患者精确定位,采用旋转聚焦原理使60℃o放射源围绕肿瘤中心作锥状非共面穿射聚焦至靶区.通常剂量为50%～65%等剂量曲线包绕靶区的95%以上;肿瘤≤5 cm的单次周边剂量3.5～4.5 Gy,肿瘤＞5 cm的单次周边剂量3.0～4.0 Gy;治疗总剂量为32～48 Gy;治疗次数8～11次,大多数患者为隔日治疗.结果伽玛刀治疗过程中既有患者上腹部及腰背部疼痛明显减轻,12位患者黄疸消退.伽玛刀治疗3个月第1次复查,病变部位达到CR:10例,PR:16例;总有效率(CR+PR)83.8%.未见穿孔、大出血、持续高热等严重并发症发生.结论体部伽玛刀治疗晚期胰腺癌能使肿瘤局部得到准确的高剂量照射,周围正常组织损伤小,近期疗效理想,为临床肿瘤医师提供了一个新的治疗手段.

To discuss the feasibility of treating Advanced Pancreatic Carcinoma(PC) with Stereotactic Radiation Treatment(SRT). 31 cases of Advanced PC were treated with OUR-QGD type Stereotactic Radiotherapy Gamma Rays System. Dose Curve of this group of cases is 50%~65%. Encircled dose of carcinoma which are less than or equal to 5 cm is 3.5~4.5 Gy per fraction, of carcinoma which are greater than 5 cm is 3.0~4.0 Gy per fraction. The range of total dose is 32~48 Gy. Number of treatment is 8~11. Majority of the patients are treated every other day. During the SRT period, significant pain relief has been observed in upper abdomen, waist and back of patients′ body, and jaundice of 12 cases has faded. After 3 months with SRT, CR is 10, PR is 16. Efficacious ratio(CR+PR) is 83.8%. No perforation, serious bleeding or continuous high fever has been discovered. [Conclusion] Treating Advanced PC with SRT ensures that Pancreatic carcinoma get exact high-dose radiation, with little damage to the normal tissues nearby. SRT has provided clinical radiotherapists with a safe and efficient treatment method.