用碘^(125)治疗不能切除的胰腺癌

Treatment of Unresectable Pancretic Carcinoma with I^(125)

目的:比较放射性I125粒子和I125+吉西他滨(gemcitabine,GEM)在治疗局部进展期胰腺癌中的作用。方法:2000年4月-2003年5月,42例局部进展期胰腺癌(locally advaced pancreatic cancer,LAPC)患者随机分成2组:A组18例(I125粒子组),B组24例(I125+GEM)。所有患者均于手术中施行了I125粒子植入术。采用改良Dimension-averaging法来计算相关剂量。37例行胆肠和(或)胃肠吻合术。结果:42例患者中,可评价客观疗效者(objective tumor response,OTR)38例,可评价临床受益反应(clinical benefit respons,CBR)者40例,可行毒性反应评价者40例。客观总有效率(CR+PR)A组为37．8％,B组为44．7％(P>0．05),PR缓解期A、B组各为6．7个月和4．8个月。CBR率A组为11．7％,B组为43．5％(P <0．05)。两组毒性反应率和并发症率没有差异。12和24个月生存率A组为41．2％、29．4％,B组为65．2％、47．8％(P= 0．04)。Ⅱ期12、24个月总生存率为71．9％、31．5％,Ⅲ期12、24个月总生存率为31．5％、7．9％(P=0．02)。结论:I125和I125+ GEM在治疗LAPC有一定的有效率,但是,I125+GEM比I125能更好地改善LAPC的生存质量,提高LAPC生存率,并且Ⅱ期患者生存率优于Ⅲ期。

Objective：To study the role of Ⅰ^125and Ⅰ^125 plus gemcitabine（GEM）in the treatment of unresectable carcinoma of the pancrease. Methods：42 patients unresectable patients with locally advanced pancreatic cancer（LAPC）were collected and randomized into Group A（Ⅰ^125 , 18 patients） and Group B（Ⅰ^125 ＋GEM, 20 patients）. Group A were treated with Ⅰ^125 implants. Group B started chemotherapy within 10-14 days post-operatively following the implant procedure. Chemotherapydose were as follows：GEM 1000mg/m weekly x 3 followed by 1 week of rest for 3 cycles. In addition,all patients undewent laparotomy. The surgical procedures performed were biopsy,gastic/biliary bypass and Ⅰ^125 implantation. The total activity and number of seeds used were as recommended by the improved dimension-averaging. Results： Overall response rate（CR＋PR） in Group A and Group B was 37. 8%and 44. 7%（P〉0.05）. PR duration in Group A and Group B was 6.7 and 4. 8 months. Clinical benefit response was experienced by 11.7% of Group A compared with 43.5% of Group B（P〈0. 05）. The survival rate of 12 and 24 months was 71.9%,31.5% for stage Ⅱ A and 31.5%,7. 9% for stage Ⅲ （P=0. 04）. The rate of complication of Group A was lower than that Group B without statistical significance. Condusion：Ⅰ^125 orⅠ^125 plus GEM is able to lead to a moderate objective response rate on the base of biliary bypass or/and gastric bypass with obstructive jaundice, but Ⅰ^125 plus GEM is more effective than Ⅰ^125 in improvement of the quality of life and survival rate in patients with LAPC.