三维适形放射治疗胰腺癌结合化疗疗效观察

Observation of the Effects of 3-dimensional Conformal Radiation Therapy Combined with Chemotherapy in Treatment of Pancreatic Cancer

目的:探讨三维适形放射治疗(3-dimensionalconformalradiationtherapy,3DCRT)结合化疗治疗胰腺癌的疗效及影响预后的因素。方法:64例胰腺癌患者中31例单独采用3DCRT,33例3DCRT前后各使用健择加顺铂方案化疗2个疗程,观察肿瘤局部缓解率及总的1、2年生存率,并用COX回归模型分析预后因素。结果:3个月、12个月肿瘤局部缓解率分别为64.1%、39.1%。总的1、2年累积生存率分别为40.2%、6.7%,中位生存期11个月。Ⅰ、Ⅱ期与Ⅲ、Ⅳ期患者1、2年生存率分别为100%、36.4%和27.4%、0(P=0.0001),单独3DCRT组1、2年生存率为28.2%、4.0%,3DCRT结合化疗组为51.5%、9.1%(P=0.0416)。多因素分析结果显示肿瘤直径、3DCRT结合化疗对患者生存率的影响有统计学意义(P<0.05)。结论:3DCRT结合化疗是影响胰腺癌患者预后的主要因素。

Objective: To investigate the effects of 3-dimensional conformal radiation therapy (3DCRT) combined with chemotherapy and the factors that influence the prognosis in treatment of pancreatic cancer. Methods: Between July 1988 to July 2000, 31 cases of the 64 patients with pancreatic cancer were treated with 3DCRT only, while the other 33 cases with 3DCRT as well as with chemotherapy by Gemcitabine (1000mg/m2, d1, d8) and Cisplatin(30mg/m2, d1~3) before and after the radiotherapy with 2 courses. The local control rates of the cancer and the overall 1-year and 2-year survival rates were noted and the factors that might have influenced the prognosis were analyzed with the Cox regression model. Results: The local control rates were 64.1% and 39.1% respectively at Month 3 and at Month 12. The overall 1-year and 2-year accumulative survival rates were 40.2% and 6.7% respectively, with the median survival time being 11.0 months. The 1-year and 2-year survival rates for patients of Stage I and II were 100.0% and 36.4%, while those for patients of Stage III and IV were 27.4%, 0.0%(P=0.000 1). The 1-year and 2-year survival rates for the group of only radiotherapy were 28.2% and 4.0%, while those for the group of combined therapy were 51.5% and 9.1% (P=0.041 6). The multiple factor analysis showed that the tumor diameter and radiotherapy combined with chemotherapy had statistically significant effects on the survival rate of the patients (P<0.05). Conclusion: 3DCRT combined with chemotherapy to treat pancreatic cancer can obviously improve the life quality and increase the survival rate of the patients, and 3DCRT combined with chemotherapy and the tumor diameter are two major prognosis factors that influence the survival rate of the patients.