放化同步治疗局部进展期胰腺癌

Concomitant chemotherapy with radiotherapy in locally advanced pancreatic cancer

目的评价放化综合治疗局部进展期胰腺癌（LAPC）的疗效.方法36例局部进展期胰腺癌采用放化同步治疗,化疗的方案分为：①5-Fu 500 mg,2次/周（13例）;②5-Fu 500 mg＋DDP30mg,1次/周（16例）;③健择（GEM）600mg,1次/周（7例）;所有病人均完成3～7周的化疗.20例采用常规放射治疗,中位照射剂量50 Gy（21～60 Gy）,16例采用三维适形放疗（3D-CRT）多野（3～5野）照射或补量,中位照射剂量60 Gy（50～70 Gy）.结果临床受益反应（CBR）：15例,占41.6%;全部患者近期疗效：CR 0,PR 4例占11.1%,SD 24例占66.6%,PD 8例占22.2%,其中3D-CRT的有效率（16.6%）高于常规放疗（5%,P=0.017）;全部病人生存率为：1年33.1%、2年11.2%.中位生存时间9.6个月（3～26个月）;1年生存率3D-CRT和常规放疗分别是41.2%和27.7%（P=0.41）;1～2度骨髓抑制41.6%（15例）,3度骨髓抑制8.3%（3例）,急性放射性胃肠炎1～2度52.8%（19例）,3度2.8%（1例）.结论对局部进展期胰腺癌采用放化综合治疗可取得一定的疗效,且毒副作用可耐受.

Objective To evaluate the effect of concurrent chemotherapy with radiotherapy for locally advanced pancreatic cancer （LAPC）. Methods Thirty-six cases of LAPC were treated with concurrent chemoradiotherapy from June 1998 to December 2004. The regimens of chemotherapy were as follows： A. 13 patients, 5-Fu 500mg, twice a week; B. 16 patients, 5-Fu 500 mg ＋ DDP 300 rag, once a week; C. 7 patients, gemcitabine （GEM） 600 mg, once a week. All the patients were administered such regimens for 3-7 weeks. Twenty patients were treated with conventional radiation therapy （ CRT）, the median dose was 50 Gy （ ranged from 21 to 60 Gy） . Sixteen patients were treated with three-dimensional conformal radiation therapy （3D- CRT）, the median dose was 60Gy （ranged from 50 to 70 Gy） . Results Clinical benefit response （CBR） was 41.6% （15/36 patients） . The overall response rates （CR ＋ PR）, SD rates, PD rates were 11.1% （4 patients）, 66.6% （24 patients）, 22.2% （8 patients）, respectively. The response rate （CR ＋ PR） of 3D-CRT was 16.6%, which was significantly higher than that in the CRT （5%） （P = 0.017）. The overall 1- and 2-year survival rates were 33.1%, 11.2 %, respectively. The 1-year survival rates were 41.2 % and 27.7 % in 3D- CRT group （ 18 patients） and CRT group （20 patients）, respectively. The difference between the two groups was statistically significant （ P = 0.41 ）. 41.6 % of the patients showed grade 1-2 hematologic toxicity, 8.3 % for the grade 3 hematologic toxicity. Grade 1-2 gastrointestinal toxicity was observed for 52.8 % patients, Grade 3 was for 2.8% patients. Conclusion The combined modality treatment is an effective method for LAPC, and the side effects are acceptable.