不同方法治疗晚期胰腺癌的临床疗效观察

Effects of 3D - CRT combined with chemotherapy and chemotherapy alone in advanced pancneatic cancer

目的观察三维适形放疗（3D—CRT）联合化疗与单纯化疗治疗晚期胰腺癌的临床疗效和毒副反应。方法我院2000年1月-2006年6月收治的40例晚期不能手术切除的胰腺癌患者。三维适形放疗（3D—CRT）与FH方案交替化疗8例，三维适形放疗联合GP方案化疗12例，单纯GP方案化疗20例。三维适形放疗技术应用CT模拟机定位，3D—TPS进行放射治疗计划设计，90％等剂量归-1．8Gy-1．9Gy／次，1次／日，5次／周，放射剂量50．4Gy-62．7Gy／5．5—7周。GP方案：健择700mg／m^2-1000mg／m^2，d1，8，顺铂20mg／m^2，d1-3，单纯化疗组28天为1周期，连用2—5周期；放化组在放疗前后各1周期。FH方案：5-Fu500mg／m^2，HCPT10mg／m^2，第1—5天和第33—38天各1周期，每次化疗结束后即开始放疗。结果GP方案单纯化疗组35％出现Ⅲ、Ⅳ级血液毒性，放疗＋GP组25％，放疗＋FH组12．5％。放化组疼痛缓解率55％，放疗＋GP组50％，放疗＋FH组62％，单纯化疗组20％。放化组有效率30％，放疗＋GP组25％，放疗＋FH组37％，单纯化疗组5％。放化组中位生存期12．0个月，放疗＋FH组12．5个月，单纯化疗组7个月。放化组1年生存率50％，放疗＋FH组62％，放疗＋GP组41％，GP方案单纯化疗组20％。结论三维适形放疗联合化疗的疼痛缓解率，有效率高于单纯化疗。三维适形放疗联合化疗较单纯化疗提高了中位生存期和1年生存率，并且副反应低。放疗＋FH方案交替在疼痛的缓解率、有效率、生存期和副反应方面有优于放疗＋GP方案的趋势。

Objective To observe the effects and toxicities of the patients with advanced pancreatic cancer treated with 3D - CRT combined with chemotherapy or chemotherapy alone. Methods 40 patients with advanced pancreatic cancer from January,2000 to June,2006 were divided into three groups：chemotherapy alone group（20 patients）3D- CRT with FH group（8 patients） 3D -CRT with GP group（ 12 patients）. Three dimensional conformal radiotherapy（3D- CRT） carried out as following： CT simulation localization,3D- TPS, time/ fraction schedule ： 1.8 - 1.9 Gy/F to the 90% isodose line, 1 F/D, 5 F/W, overall rate： 50.4 - 62.7 Gy. Chemotherapy：GP scheme：gemcitabine 700 - 1000/m^2 d1,8 and Cisplatin 20 mg,/m^2d1 - 3, GP scheme was applied one cycle at every four weeks and two to five cycles in chemotherapy alone group, and one cycle before and after radiation in 3 D - CRT with GP group;FH scheme ：5 - Fu 500 mg/m^2 and Hcpt 10 mg/m^2 delivered respectively in five days continually, then radiated, when dose achieved 40 Gy, the other cycle was given immediately, then radiated again. Results The side effect of 3D - CRT with chemotherapy group was slighter than that of chemotherapy alone group, especially in the FTI group. The rate of pain palliation of them were 55% and 20% respectively（ P 〈 0. 05）and is higher in the FH group（62% ）. Five patients experienced partial response and one complete response in the 3D - CRT with chemotherapy group,but partial response was observed in only one patient of the chemotherapy alone group（P 〈0.05） ,and the better effect was observed in the FH group,though without a statistical difference. The median survival from the time of therapy was 12 months in 3D - CRT with chemotherapy group, higher than that of chemotherapy alane group（ P 〈 0. 05 ）. The survival rate of 1 year in the former was better, especially in the FH group （ P 〈 0.05 ）. Conclusion The rate of pain palliation was higher in 3 D - CRT with chemotherapy group than that of chemotherapy alone group. Better general remission was achieved in the former and the efficacy of the treatment in terms of prolongation of life was proven in the same group, but the side effect was slighter in this group. At the same time, the better effect and slighter toxicity were observed in clinical in the 3D - CRT with FH group than with GP group.