间质化疗联合放疗治疗局部晚期胰腺癌的疗效观察

Stroma Chemotherapy plus Radiotherapy for Localized Advanced Pancreatic Cancer:Observation of Curative Effect

目的:观察间质化疗联合放疗治疗局部晚期胰腺癌的疗效及不良反应。方法:局部晚期胰腺癌患者48例,Ⅲ期38例,Ⅳ期10例,按随机数字分为实验组(放疗+间质化疗)和对照组(放疗+全身化疗),每组各24例患者。间质化疗:在CT引导下穿刺将氟尿嘧啶缓剂植入肿瘤体内。化疗:采用氟尿嘧啶注射剂500 mg,静滴连用5天。放疗:采用三维适形放射治疗,Dt=40GY,3GY/次,2次/周。结果:(1)近期疗效:治疗组:CR 3例,PR 13例,SD 7例,PD 1例;对照组:CR 1例,PR 8例,SD 12例,PD 3例,两组比较差异无统计学意义(χ2=4.506,P=0.212)。(2)生存率比较:1年生存率:治疗组25%,对照组12.5%,两组差异无统计学意义(χ2=2.946,P=0.086)。(3)CBR:治疗组:有效14例,稳定10例;对照组:有效10例,稳定17例,两组差异有统计学意义(χ2=4.648,P=0.042)。(4)毒性反应:Ⅰ-Ⅱ级消化道反应,治疗组15例,对照组24例,两组差异有统计学意义(χ2=11.077,P=0.001);Ⅰ-Ⅲ级消化道反应,治疗组17例,对照组24例,两组差异有统计学意义(χ2=8.195,P=0.004)。结论:间质化疗联合放疗与化疗联合放疗相比,不能提高局部晚期胰腺癌患者的近期疗效和生存率,但能提高CBR,化疗放疗不良反应轻。

OBJECTIVE： To evaluate the therapeutic effect and adverse effect of stroma chemotherapy combined radiotherapy in the treatment of localized advanced pancreatic cancer. METHODS： 48 patients with localize advanced pancreatic cancer （38 were at Ⅲ stage and 10 Ⅳ stage） were randomly assigned to experiment group （radiotherapy plus stroma chemotherapy, n = 24 ） or control group （radiotherapy plus systemic chemotherapy, n = 24 ）. In stroma chemotherapy, the patients were implanted with fluorouracil retarder under the guidance of CT. Chemotherapy： Fluorouracil 500mg was administered by iv gtt for 5 days. Radiotherapy： deploying 3DCRT, Dt = 40GY, 3GY/time, twice a week. RESULTS： The recent therapeutic effect showed no statistical significance between the two groups （χ^2 = 4.506, P = 0.212） （3 CR, 13 PR, 7 SD, and 1 PD in experiment group versus 1 CR, 8 PR, 12 SD, and 3 PD in control group） . The 1 - year survival rate showed no statistical significance between the two groups （χ^2 = 2.946, P = 0.086） （25% for experiment group versus 12.5% for control group）. There were statistical significances between the two groups in CBR χ^2 = 4.648, P = 0.042） （14 PR and 10 SD in experiment group versus 10 PR and 17 SD in control group） and toxic reactions （17 versus 14 with Ⅰ - Ⅱ grade reaction of esophagus,χ^2 = 11.077, P = 0.001 ; 17 versus 24 with Ⅰ- Ⅲ grade reaction of esophagus, χ^2 = 8.195, P = 0.004）. CONCLUSION： As compared with chemotherapy plus radiotherapy, stroma chemotherapy combined radiotherapy can＇ t improve the short - term efficacy and survival rate, but can improve CBR while reducing toxicity of radiochemotherapy for patients with localized advanced pancreatic cancer.