三维适形放疗联合热化疗治疗局部晚期胰腺癌的临床观察

Clinical efficacy of three-dimensional conformal radiotherapy combined with thermochemotherapy inthe treatment of locally advanced pancreatic cancer

目的评价三维适形放疗联合热化疗对局部晚期胰腺癌的临床疗效。方法将2008年6月至2011年6月间本院收治的70例局部晚期胰腺癌患者分为两组：单纯放疗组30例仅采用单纯放疗，综合治疗组40例在放疗同时及以后给予热化疗。放疗采用三维适形放疗，90％-95％等剂量曲线，单次剂量1．8-2．0Gy，总放射剂量50-70Gy；热化疗自三维适形放疗开始后同步进行，热疗时维持温度41．5-43．5℃，每次1h，每周2次，共6次。热疗中同时给予注射用三氧化二砷20mg、重组改构人肿瘤坏死因子1000万U静脉滴注，进行4-6次，或三维适形放疗同时及治疗后给予吉西他滨0．6-1．0g／m。dl、8静脉滴注；顺铂20-30mg／m。dl-3静脉滴注，每28天重复一次，总疗程3-6个周期。结果治疗后3个月综合治疗组总有效率CR＋PR为70．0％（49／70），其中放疗联合化疗组、放疗联合热化疗组有效率分别为56．5％、88．2％，单纯放疗组有效率56．7％。放疗联合热化疗组有效率与放疗联合化疗组、单纯放疗组相比差异均有统计学意义（X^2=4．68，4．98，P〈0．05），而后两者比较差异无统计学意义（P〉0．05）。全组1年、2年生存率分别为46．8％和20．3％，其中综合组分别为52．4％和26．7％，单纯放疗组分别为42．5％和16．2％，两组1年、2年生存率比较差异均有统计学意义（X^2=14．17，P〈0．05；X^2=9．74，P〈0．05），治疗及随访期间未见穿孔、大出血、持续高热等严重并发症。结论三维适形放疗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，且能提高患者生存质量及生存期，是治疗局部晚期胰腺癌较好的方法。

Objective To evaluate the clinical efficacy of three-dimensional conformal radiotherapy （3D-CRT） combined with thermochemotherapy in the treatment of locally advanced pancreatic cancer （LAPC）. Methods From June 2008 to June 2011, 70 patients with LAPC were divided into radiotherapy group （30 patients） and combination group （40 patients）. Radiotherapy used 3D-CRT with a 90% to 95% isodose curve, a single dose of 1.8 to 2. 0Gy, and total radiation dose 50 - 70 Gy. The combination group patients received simultaneous thermotherapy at 41.5 -43.5 ℃ （1 h/fraction, twice a week for 6 times）, and hyperthermia given simuhaneously injected using arsenic trioxide 20 mg, recombinant mutant human tumor necrosis factor（rmhTNF） intravenous infusion of 10 million U, 4 to 6 times, or 3D-CRT at the same time and the treatment given after gemcitabine（0. 6 （20 - 30 mg/m^2） on Days dl-3 intravenous infusion, 1.0 g/m^2 ） on Days dl and 8 and cisplatin （DDP） 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. 0% （49/70）, the efficiency of radiotherapy combined with chemotherapy, and radiotherapy combined with ther- mo-chemotherapy were 56. 5% and 88. 2%, and the radiotherapy alone group was 56. 7%. There were sig-nificant difference in efficiency between radiotherapy combined with thermo-chemotherapy group compared to radiotherapy-chemotherapy group and radiotherapy group （ X^2 = dr. 68 ,4. 98, P 〈 0.05）, the last two groups showed no significant difference （ P 〉 0.05）. The 1-year and 2-year survival rate was 46. 8% and 20. 3% ,respectively. The 1-year and 2-year survival rates were 52.4% and 26.7% in combination group, and 42. 5% and 16. 2% in radiotherapy group （ X^2 = 14. 17, P 〈 0. 05 ; X^2 = 9. 74, P 〈 0. 05 ）. No serious complications such as perforation, bleeding, and high fever were seen during treatment and follow-up. Con- clusions 3D-CRT combined with thermochemotherapy is well tolerated and is relatively effective for the LAPC patients