体部γ-刀治疗52例胰腺癌的疗效分析

Analysis of clinical outcomes of body gamma knife therapy for 52 patients with advanced pancreatic carcinoma

目的观察评价体部γ-刀治疗中晚期胰腺癌的疗效和放射反应。方法对52例Ⅱ～Ⅳ期胰腺癌采用体部γ-刀治疗,治疗时采用体架和真空负压袋固定体位,CT 扫描和三维计划,PTV在 GTV 外扩1cm,50%剂量线为处方剂量线,胰头癌3～4Gy/次,胰体尾癌4～5Gy/次,5次/周,肿瘤边缘总剂量40～51Gy,肿瘤中心区域80～102Gy。结果原发灶的完全缓解率(CR)19.2%,部分缓解率(PR)69.2%,总有效率(CR+PR)88.4%。Ⅱ～Ⅳ期1、2年总生存率分别为56.5%和23.1%。Ⅱ期1、2年生存率分别为76.9%和46.7%;Ⅱ期和Ⅲ～Ⅳ期的2年生存率间的差异有显著性意义。治疗期间胃肠反应 RTOG Ⅰ～Ⅱ级为57.3%,Ⅲ级5%,经对症处理病人均能按计划完成治疗。结论体部γ-刀治疗胰腺癌采用3～5Gy/次,5次/周,肿瘤边缘50%剂量线处总剂量45～51Gy 的治疗模式是安全有效的,对不能手术的局部晚期可提高局控率和生存率。

Objective To evaluate the efficacy of body gamma knife treatment for stage Ⅱ -Ⅳ pancreatic carcinoma （PC） and investigate the reaction of patients to the treatment. Methods From August 2000 to February 2003, 52 patients with stage Ⅱ-Ⅳ PC were treated with the Stereotactic Gamma Ray Whole-body Therapeutic System （body gamma knife） in our hospital. For body gamma knife treatment, a stereotactic body frame for exact tumor localization, reproducible fixation, CT sim- ulation and 3-D treatment plan was developed. The margin of PTV was over 1 cm in GTV, 50% dose line was prescribed dose curve and covered over 95% area of PTV. The patients with pancreatic head carcinoma were irradiated with 3-4 Gy/fraction at 50% dose line. For patients with tumors of the pan- creatic body and tail, the irradiation with 4-5 Gy/fraetion at 50% dose line was performed, 5 d a week and a total dose of 40-51Gy was delivered at the tumor margin. Meanwhile, the total dose of 80-102 Gy was delivered at the tumor central area. Results The complete response rate （CR） and partial response rate （PR） in the primary tumor were 19.2% and 69.2%, respectively, and the overall response rate （CR＋PR） was 88. 4% 2-3 months after the treatment. The 1-, 2-year overall survival rates were 56.5% and 23. 1% for patients with tumor of stage Ⅱ-Ⅳ and 76.9% and 46.7% for those with tumor of stage Ⅱ, respectively. Acute gastrointestinal reactions were found in 57.3% for RTOG grade Ⅰ-Ⅱ and 5 % for RTOG grade Ⅲ. The whole process was bearable for all the patients after allopathy. Conclusions This new technique, which is non-invasive and painless, is effective and safe and can improve the local control rate and survival rate for patients with local advanced pancreatic cnrcinoma thnt is not resectable.