局部晚期胰腺癌三维适形放射治疗与γ射线体部立体定向放射治疗加量疗效分析

Effect of three-dimensional conformal radiotherapy or dose boosted combined with gamma ray stereotactic body radiotherapy on advanced local pancreatic carcinoma

目的回顾性分析局部晚期胰腺癌患者接受直线加速器X射线常规三维适形放射治疗(简称放疗)(3D-CRT组)与常规适形放疗加γ射线体部立体定向放疗加量治疗(SBRT加量组)之间的疗效差异。方法 40例局部晚期胰腺癌患者,其中男性22例,女性18例;年龄46～83岁,中位年龄72岁。3D-CRT组28例,SBRT加量组12例。ⅡA期(T3N0)6例,ⅡB(T1-3N1)5例,Ⅲ(T4N0-1)29例。单纯3D-CRT组计划总剂量46～50 Gy。SBRT加量组的常规适形放疗剂量计划为40 Gy(20次),然后采用SBRT追加加量16Gy(8次)。结果中位随访时间27个月(随访时间3～44个月),全组适形放疗中位肿瘤靶体积(GTV)为75.3 mL(GTV为17.5～191.7 mL),中位CTV为349.7 mL(CTV为114.4～727.9 mL)。SBRT加量CT定位时中位GTV为47.5mL(GTV为11.7～96.9mL)。3D-CRT组中位照射剂量46Gy(照射剂量18～50Gy),SBRT组适形放疗中位照射剂量40 Gy(照射剂量40～46 Gy),γ射线立体定向放疗加量中位照射剂量16 Gy(照射剂量14～20 Gy)。全组中位生存时间8.4个月(生存时间1.4～35.1个月),3D-CRT组与SBRT组的中位生存时间分别为8.2个月(生存时间1.4～21.2个月)、17.7个月(生存时间2.9～35.1个月),P>0.05。两组治疗相关急性和后期副反应差异无统计学意义。结论对于局部晚期胰腺癌患者,适形放疗加γ射线立体定向放疗加量耐受性好,有提高生存期的趋势。能否真正地提高生存率,有待进一步扩大样本研究。

Objective To retrospective analyze the efficacy differences between linear accelerator X-ray three-dimensional conformal radiotherapy（3D-CRT） and dose boosted combined with conventional conformal gamma ray stereotactic body radiotherapy（SBRT） for advanced local pancreatic carcinoma patient.Methods A total of 40 patients with advanced local pancreatic carcinoma were enrolled,male 22,female 18,aged 46-83 years old,median age 72 years old.Among these patients 28 cases were performed by 3D-CRT（3D-CRT group）,12 cases by SBRT（SBRT group）.In these patients there were 6 cases of stageⅡA（T3N0）,5 ofⅡB（T1-3N1） and 29 of Ⅲ（T4N0-1）.Total scheduled dose was 46-50 Gy for 3D-CRT group;for SBRT group,16 Gy in 8 fractions with SBRT were boosted after 40 Gy of 3D-CRT.Results The median follow-up time was 27 months（3-44 months）,the median gross target volume（GTV） and clinical target volume（CTV） of total cases were 75.3 mL（17.5-191.7 mL） and 349.7 mL（114.4-727.9 mL） respectively.The median dose was 46 Gy（18-50 Gy） for 3D-CRT group and 56 Gy（54-66 Gy） for SBRT group.The median survival time was 8.4 months（1.4-35.1 months） for all cases.The median survival time of 3D-CRT group and SBRT group were 8.2 months（1.4-21.2 months） and 17.7 months（2.9-35.1 months）（P〉0.05）.There were no statistic differences between 2 groups in terms of side effects induced by treatments.Conclusion For advanced local pancreatic carcinoma patients,the treatment of 3D-CRT combined with gamma ray SBRT have good tolerance and the survival rate is increased,but further large scale treatments should be studied.