低分割适形放疗同步单药吉西他滨治疗不可切除胰腺癌的疗效分析

Effect of hypofractionated three dimensional conformal radiotherapy with concurrent weekly medium-dose gemcitabine in patients with unresectable pancreatic cancer

目的:采用低分割和高剂量适形放疗同步中等剂量单药吉西他滨治疗不可切除胰腺癌患者的疗效及安全性。方法:23例不可手术切除的胰腺癌患者接受同步放化疗,放疗采用低分割、高剂量适形放疗模式,单次剂量为3～4Gy,3次/周,DT:36～58Gy;同步化疗采用单药吉西他滨每周600～750mg/m2,静脉滴入,1次/周,共7周;观察有效率、中位生存期和1年生存率及不良反应。结果:有效率(CR+PR)为34.8%;1年生存率为39.1%;中位生存期为10.2个月。单因素分析生存期与肿瘤临床分期、肿瘤标志下降程度、放疗剂量和临床疗效及是否维持化疗密切相关P<0.05。有7例患者出现Ⅲ～Ⅳ级不良反应,其中5例表现为血小板下降,对症治疗可恢复,无治疗相关死亡事件发生。结论:低分割、高剂量适形放疗同步中等剂量单药吉西他滨是不可切除胰腺癌一种有效安全的治疗模式。

OBJECTIVE： To examine the feasibility and safety of concurrent use of medium-dose gemcitabine （GEM） and hypofractionated three dimensional conformal radiotherapy for unresectable pancreatic cancer. METHODS： Twenty three patients with unresectable pancreatic cancer were subjected to concurrent chemoradiotherapy （GEM 600 ～ 750 mg/m2 weekly for 7 weeks）. They received limited-field and hypofractionated （36～58 Gy in 3～4 Gy,3 F/week） irradiation by three-dimen- sional radiotherapy planning. RESULTS： Of the 23 patients, the response rate amounted to 34. 8%, the median survival time （MST） was 10.2 months, and 1-year survival rate was 39.1%. MST was associated with clinical stage,level of tumor marker,radiation dose, response rate and maintenance chemo- therapy （P〈0.05）. Grade Ⅲ～Ⅳ toxicity was detected in seven patients, 5 patients was thrombocytopenia. CONCLUSION： Limited-field and hypofractionated radiotherapy enables the safe concurrent administration of GEM for unresectable pancreatic cancer.