姑息手术结合术中碘125粒子植入和术后化疗治疗晚期胰腺癌

Treatment of advanced unresetable pancreatic cancer by palliative operation combined with ^125I brachytherapy and chemotherapy

目的总结姑息性手术结合术中^125I粒子永久性组织间植入和术后吉西他滨化疗等综合治疗措施对晚期无法切除胰腺癌的临床疗效。方法对我院胰腺外科中心2001年至2004年间83例接受治疗的晚期无法切除胰腺癌患者的临床资料进行回顾性分析。结果83例患者中行姑息手术29例（A组），姑息手术＋吉西他滨化疗42例（B组），姑息手术＋^125I粒子植入＋吉西他滨组12例（C组）。A、B和C组客观有效率，第3月时分别为0．00％（0／27）、24．4％（10／41）和33．3％（4／12），第6月时分别为0．0％（0／16）、21．6％（8／37）和33．3％（4／12）。各组临床受益率，第3月时分别为14．8％（4／27）、41．5％（17／41）和50．0％（6／12），第6月时分别为6．3％（1／16）、21．6％（8／37）和50．0％（6／12）。A、B和C组的中位生存期分别为6．2、8．3和8．6月，1年累积生存率分别为6．9％（2／29）、21．4％（9／42）和25．0％（3／12），A、B、C组间逐渐增高，B、C组与A组的差异有统计学意义（P〈0．01），但B、C组间差异无统计学意义（P〉0．05）。结论对晚期无法切除胰腺癌患者，姑息性手术结合术后吉西他滨化疗可改善患者生活质量，提高1年生存率。而^125I粒子组织间放射结合术后化疗能改善患者生活质量。

Objective To study the clinical effect of palliative operation combined with intraoperative brachytherapy of I seeds and post-operative gemcitabine chemotherapy for unresectable pancreatic cancer. Methods Clinical data of 83 cases of unresectable pancreatic cancer during 2001 and 2004 were retrospectively analyzed. Results Patients were divided into 3 groups, palliative operation group （29 cases, group A ）, palliative operation ＋ pest-operative chemotherapy group （ 42 cases, group B ） and palliative operation ＋ post-operative chemotherapy ＋ intra-operative brachytherapy group （ 12 cases, group C）, the clinical effect of each group were evaluated. Objective tumor response （OTR） of group A, B and C were0.0% （0/27）, 24.4% （10/41） and 33.3% （4/12） in the 3rd month, 0% （0/16）, 21.6% （8/37） and 33, 3% （4/12） in the 6th month, respectively, Clinical benefit response （CBR） of group A, B and C were 14, 8% （4/27）, 41.5% （ 17/41 ） and 50. 0% （6/12） in the 3rd month, 6. 3% （ 1/16）, 21, 6% （8/37） and 50. 0% （6/12） in the 6th month, respectively. The median survival of patients in group A, B and C were 6. 2, 8.3 and 8, 6 months, respectively. One year survival rate was 6. 9% （2/29）, 21,4% （9/42） and 25.0% （3/12） , respectively, One year survival rate in group B and C was higher than in group A （ P 〈 0. 01 ）, Conclusions Treatment of unresectable pancreatic cancer by palliative operation combined with chemotherapy improves quality of life and survival rate more efficiently, though compared with chemotherapy only,brachytherapy plus chemotherapy fail to further improve patients＇ one year survival rate.