伽玛刀联合吉西他滨与联合复方苦参治疗局部晚期胰腺癌的比较研究

Comparative Study of Logically Advanced Pancreatic Cancer Using Gamma Knife Together with Compound Kushen and Gemcitabine

目的:比较伽玛刀联合吉西他滨与伽玛刀联合复方苦参注射液治疗局部晚期胰腺癌的疗效及不良反应。方法:对65例局部晚期胰腺癌行伽玛刀治疗,一般剂量为50%～65%等剂量曲线包绕靶区的95%以上,小于5cm的肿瘤周边剂量每次为3～4Gy,大于5cm的肿瘤周边剂量每次为2.5～3.5Gy;治疗总剂量为35～45Gy;治疗次数8～12次,患者通常每日一次。其中治疗组34例接受化疗:吉西他滨1000mg/m2,第1天、第8天静脉滴注,间隔3周重复,共3周期。对照组31例从伽玛刀治疗前一周给予输注复方苦参注射液,30ml/d,共3周。结果:伽玛刀治疗联合吉西他滨组临床受益反应率为79.4%(27/34),伽玛刀治疗联合复方苦参组临床受益反应率80.6%(25/31),两组比较差异无统计学意义(P>0.05);前者近期疗效为79.4%(27/34),后者为80.6%(25/31),两组比较差异无统计学意义(P>0.05);不良反应中血液学毒性比较,治疗组白细胞降低发生率为88.2%(30/34),对照组白细胞降低发生率为29%(9/31),两组比较差异具有统计学意义(P<0.01);治疗组血小板下降发生率61.8%(21/34),对照组血小板下降发生率22.6%(7/31),两组比较差异有统计学意义(P<0.01);胃肠道反应,治疗组中发生率为55.9%(19/34),对照组中发生率为38.7%(12/31),两组比较差异无统计学意义(P>0.05)。结论:治疗组与对照均取得了好的治疗效果,但两组治疗效果无明显差异,且治疗组毒副作用明显增加,对照组在提高伽玛刀近期疗效的同时可以降低伽玛刀治疗毒性反应的发生率,改善生活质量,可以作为临床放疗的良好的辅助药物,值得在临床工作中推广。

Objective：To comparate study of short-term clinical efficacy of locally advance pancreatic cancer using gamma knife together with compound kushen and gemcitabine.Method：65patients with advanced pancreatic cancer were treated using gamma ray knife.The gamma knife treatment applied 50%-65% dose isodose curve surrounding the target area more than 95%, using a single peripheral dose of 3.0-4.0 Gy for the tumor = 5 cm and a single peripheral dose of 2.5 to 3.5 Gy.A total dose of 35-45 Gy was applied for each patient,with treatment times 8-12,and 1 time/ d.the treatment groups： Chemotherapy was carried out using gemcitabine 1000 mg/m2 for intravenous injection at the first day and the eighth day,repeating every 3 weeks for 3 cycles. As a contrast,compound kushen was used one week before gamma knife treatment.30 ml/time,1 time/d,3 weeks.Result：The clinical benefit response rate for the combined treatment group and the control group was 79.4% （27/34 ） and 80.6% （25/31）,respectively （no significantly at alpha 0.05）.The term efficacy for the combined treatment group and the control group was 79.4% （27/34） and 80.6% （25/31）,respectively （no significantly at alpha 0.05）.Comparisons of adverse reactions in hematological toxicity shows that leukopenia and thrombocytopenia occurred in the combined treatment group 88.2%（30/34） 50.0%（15/30） and 61.8% （21/34） and those for the control group 29%（9/31）and 22.6%（7/31）were respectively.（Significantly at alpha 0.01）.The combined treatment group had 55.9 %（19/34） of non-hematological toxicity and gastrointestinal tract reaction, the control group of. 40.6%（13/32）, significantly more than （no significantly at alpha 0.05）.Conclusion：Treatment group and control of locally advanced pancreatic cancer has exact effect, and its short-term effect is well and no significant difference in the effect of treatment in both groups. But the toxic effects of the control group significantly increased.Together with gemcitabine, patients benefit more significantly of joint compound Kushen liquid, and it reflected a significant advantage.It can be used as a good adjuvant drug in clinical radiotherapy.