大剂量分割适形放射治疗胰腺癌23例

Conformal Radiation Therapy of Accelerated Fraction for 23 Patients with Pancreatic Carcinoma

目的：探讨大剂量分割适形放射治疗胰腺癌的疗效及其放射损伤。方法：对23例胰腺癌患者原发灶及其肝转移灶共39个病灶行大剂量分割立体定向适形放射治疗。各靶灶中心剂量平均为40．4Gy，分5～12次完成。分割剂量平均5．4Gy，疗程平均20．4天。治疗中部分病例辅以思密达以保护胃肠道粘膜。结果：所有病例均随诊1年以上，有9例随诊2年以上。治疗后1～3月复查，所治疗39个病灶中，CR占23．1％；PR占40．0％；NC占26．4％；PD占7．7％；1例患者于治疗结束后10日出现上消化道大出血而死亡。病灶1年局部控制率为48．7％（19／39）。用直接法统计，1年生存率为60．8％，2年生存率为33．3％。3例黄疸患者有2例治疗后黄疸明显消退。胃肠道反应发生率为52．7％。23例中有3例出现白细胞下降。未发现其它副作用。结论：大剂量分割适形放射治疗将是一种对胰腺癌较有前途和潜力的治疗方式，有必要对其进行继续研究。

Objective To evaluate the effect and radiative injuries of conformal radiation therapy of accelerated fraction for pancreatic carcinoma． Methods From October 1996 to February 1998 thirty－nine tumor targets were treated by conformal radition therapy of accelerated fraction． The average isocenter dose in all 39 tumor targets was 40．4Gy for 5－12 sessions． The average fractional dose was 5．4Gy and mean therapeutic time was 20．4 days． Smecta was used to protect stomach mucosa in some patients． Results All patients were followed up for one year or more 9 patients of them were followed up for 2 years or more． Within the first trimester after treatment the local effect in all 39 tumor targets were CR 23．1％ PR 40．0％ NC 26．4％ PD 7．7％． One patient died of upper gastrointestinal bleeding ten days after treatment． The local control rate within 2 years was 48．9％ 19／39． The 1－ 2－ year survival rates were 60．8％ and 33．3％ respectively． Two of the three jaundeced patients had their jaundice reduced obviously after treatment． The incidence rate of G－I reaction was 52．7％ and leukopenia was observed in 3 patients． Conclusion 1 The curative effect of conformal radiation of accelerated fraction for pancreatic carcinoma is inspired． 2 Severe upper G－I tract bleeding occurred in 2 cases． No other serious complications were found． 3 We conclude that conformal radiation of accelerated fraction is a potential method for patients with pancreatic carcinoma．