伽玛刀联合热化疗治疗局部晚期胰腺癌的疗效

Efficacy of Whole Body γ-Knife Radiotherapy Combined with Thermochemotherapy on Locally Advanced Pancreatic Cancer

背景与目的:放疗及化疗等非手术治疗是局部晚期胰腺癌主要的治疗手段,本研究旨在评价三维立体定向伽玛刀治疗联合热化疗对局部晚期胰腺癌的临床疗效。方法:将2001年12月至2006年1月收治的75例局部晚期胰腺癌患者分为两组,其中37例仅采用单纯放疗,38例在放疗的同时及以后给予热化疗。放疗采用三维立体定向伽玛刀治疗,50%～60%等剂量曲线,单次周边剂量3.0～4.5Gy,治疗8～12次,热化疗自伽玛刀治疗开始后同步进行。热疗时维持温度41.5～43.5℃,每次1h,每周2次,共6次。热疗中同时给予替加氟0.6～1.0g,亚叶酸钙0.2g静脉滴注,进行4～6次;或伽玛刀治疗同时及治疗后给予吉西他滨0.6～1.0g/m2d1,8静脉滴注;顺铂20～30mg/m2d1～3静脉滴注,每28天重复一次,总疗程3～6周期。结果:治疗后3个月全组总有效率(CR+PR)为70.7%(53/75),综合组与单纯放疗组的有效率分别为73.7%、67.6%。全组1年、2年生存率分别为48.3%和22.1%,其中综合组分别为51.2%和26.5%,单纯放疗组分别为45.2%和17.6%。治疗及随访期间未见穿孔、大出血、持续高热等严重并发症。结论:三维立体定向伽玛刀联合热化疗治疗局部晚期胰腺癌患者近期疗效满意,毒副反应可耐受,且能提高患者的生存质量及生存期,是治疗局部晚期胰腺癌较好的方法。

BACKGROUND ＆ OBJECTIVE： Radiotherapy and chemotherapy are major therapies for locally advanced pancreatic cancer. This study was to evaluate the efficacy of three-dimensional conformal γ-knife radiotherapy combined with thermochemotherapy on locally advanced pancreatic cancer. METHODS： From December 2001 to January 2006, 75 patients with locally advanced pancreatic cancer were divided into radiotherapy group （37 patients） and combination group （38 patients）. All patients received γ-knife radiotherapy using Stereotactic Radiotherapy Gamma Rays System, with iso-dose curves of 50%-60%, tumor encircling dose of 3.0-4.5 Gy per fraction, 8-11 fractions. The patients in combination group received simultaneous thermotherapy at 41.5-43.5℃ （1 h/fraction, twice a week for 6 times）, and chemotherapy with venous administration of tegafur （0.5-1.0 g） and calcium folinate （CF, 0.2 g） for 4-6 times, or venous administration of gemcitabine （0.6-1.0 g/m2） on Days 1 and 8 and cisplatin （DDP） （20-30 mg/m2） on Days 1-3, repeated every 28 days for 3-6 cycles. RESULTS： At 3 months after treatment, the total response （complete remission and partial remission） rate was 70.7% （53/75）; the response rate was 73.7% in combination group and 67.5% in radiotherapy group. The 1-year survival rate was 48.3%, and the 2-year survival rate was 22.1%. The 1- and 2- year survival rates were 51.2% and 26.5% in combination group, and 45.2% and 17.6% in radiotherapy group. No serious complications, such as perforation, bleeding and high fever, were seen during treatment and followup. CONCLUSION. 3-D conformal γ-knife radiotherapy combined with thermochemotherapy is well tolerated and is relatively effective for most patients with locally advanced pancreatic cancer.