应用立体定向适形放射治疗技术治疗胰腺癌的时间剂量分割模式探讨

The exploration on time-dose fraction scheme using stereo-tactic conformal radiotherapy technique for pancreatic cancer

目的：探讨应用立体定向适形放射治疗技术治疗胰腺癌的最佳时间剂量分割模式。方法：58例不能手术治疗的局部晚期胰腺癌患者分为常规放疗组（28例）和非常规放疗组（30例），分别接受常规剂量常规分割和非常规剂量常规或低分割立体定向适形放射治疗，等效生物剂量均为55Gy左右。放疗结束后应用5-FU化疗2～4周期。按世界卫生组织（WHO）制定的肿瘤客观疗效评价标准对两组患者近期疗效进行观察比较；按美国放射肿瘤学会协作组（RTOG）制定的早期放射损伤分级标准对两组患者急性放射反应进行观察比较；对两组患者中位生存期、临床受益反应进行观察对比。结果：常规放疗组和非常规放疗组患者治疗结束后3个月疗效分别为42．86％和50．00％（P〉0．05）；常规放疗组和非常规放疗组患者中位生存期分别为13个月和12个月（P〉0．05）；临床受益反应率分别为64．29％和36．67％（P〈0．05）。3级以上急性放射损伤主要为消化道反应和骨髓抑制，常规放疗组和非常规放疗组发生率分别为7．14％、7．14％和33．33％、40．00％，两组间比较差异显著（P〈0．05）。结论：应用立体定向适形放射治疗技术常规剂量常规分割治疗胰腺癌急性放射反应轻，能够有效改善患者的生存质量，是一种合理的治疗模式。

Objective ：To explore the ideal time-dose fraction scheme using stereo-tactic conformal radiotherapy technique for pancreatic cancer. Methods：Fifty-eight patients with non-operative locally advanced pancreatic cancer were divided into routine radiotherapy group and unconventional radiotherapy group. Two groups were treated individually by routine dose and high dose conventional fraction stereo-tactic conformal radiotherapy. Biological effective dose （BED） was 55 Gy. One or two weeks after radiotherapy was accomplished,5-FU project adjuvant chemotherapy was followed for 2-4 cycles. According to the evaluation standard of the tumor objective treatment effect of WHO and the acute side effects RTOG criterion system,the short-term response rate,median survival time,clinical benefit response rate and acute radiation injury rate were observed and compared. Results：The short-term response rates were 42. 86% and 50.00% respectively, which had no significant difference between the two groups（ P 〉 0. 05 ） three months after the treatment. The median survival time were 13 months and 12 months respectively, which had no significant difference between the two groups （P 〉 0. 05 ）. Clinical benefit response rates were 64. 29% and 36. 67%, which had significant difference between the two groups （P 〈 0.05 ）. The main toxicities of grade Ⅲ included the digestive tract reactions and bone marrow depression. Acute radiation injury rates were 7. 14% ,7. 14% and 33.33 % ,40. 00% respectively, which had significant difference between the two groups （P 〈 0. 05 ）. Conclusion： Applied stereo-tactic conformal radiotherapy technique with routine dose conventional fraction radiotherapy for pancreatic cancer may relieve acute radiation reactions, It is an effective approach to improve life quality. The study indicates that it is a reasonable therapeutic scheme.