胰腺癌精确放疗的疗效及预后因素

Effectiveness and Prognostic Factors of Precise Radiotherapy for Pancreatic Cancer

目的 分析胰腺癌的精确放疗疗效及预后因素.方法 2003年1月至2012年6月间接受精确放疗的胰腺癌患者102例,其中根治性放疗54例,辅助性放疗48例；三维适形放疗平均16例,调强放疗86例；中位放疗剂量50 Gy,1.8～2.2 Gy/次.13例同步卡培他滨化疗.结果 所有患者总生存时间（overall survival,OS）为（14±1.2）个月,无进展生存时间（progress-free survival,PFS）为（9±1.1）个月.1、2、5年生存率分别为63.3％、22.6％、10％.毒性反应包括3级消化道毒性5例,未发生3、4级血液学和4级消化道毒性反应.单因素分析结果表明,治疗前体重下降＞5 kg（P ＜0.0001）、T分期（P =0.011）、TNM分期（P =0.007）、是否行肿瘤切除术（P =0.001）是影响OS的预后因素,同时也是PFS的预后因素.多因素分析结果表明,肿瘤切除术是OS的预后因素（x2=5.416,P=0.020）.结论 在胰腺癌的根治性放疗和辅助性放疗中,三维适形放疗和调强放疗都可以较好地耐受,3、4级毒性反应较少,为放化疗同步及肿瘤放疗剂量的提升提供了可行性；手术切除提高了OS.

Objective To analyze the effectiveness and prognostic factors of precise radiotherapy for pan- creatic cancer. Methods Totally 102 patients with pancreatic cancer received precise radiotherapy in our hospi- tal between January 2003 and June 2012, among whom 54 received radical radiotherapy and 48 underwent adju- vant radiotherapy. Three-dimensional conformal radiotherapy （3D-CRT） was performed in 16 cases and intensity- modulated radiotherapy （IMRT） in 86 cases, with a median radiotherapy dose of 50 Gy （ 1.8 ~ 2. 2 Gy/frac- tion）. Concurrent capecitabine chemotherapy was carried out in 13 cases. Results The average overall survival time （OS） and the average time to progress-free survival （PFS） was （ 14 _＋ 1.2） months and （9 -＋ 1.1 ） months, respectively. The 1-, 2-, and 5-year survival rates were 63.3% , 22.6% , and 10% , respectively. Grade 3 gas- trointestinal toxicity occurred in 5 cases. No grade 3 or 4 hematologic toxicity and grade 4 gastrointestinal toxicity was observed. Univariate analysis showed that weight loss of 〉 5 kg before treatment （ P 〈 0. 0001 ）, T stage （P =0. 011 ）, TNM stage （P =0. 007）, and surgical excision （P =0. 001 ） were significantly associated with OS and PFS. Multivariate analysis showed that surgical excision was a prognostic factor for OS （X2 = 5. 416, P = 0. 020）. Conclusions The precise radiotherapy including 3D-CRT and IMRT can be tolerated with fewer grade 3 and 4 toxicities in pancreatic cancer patients after radical radiotherapy and adjuvant radiotherapy, thus make it feasible for the concurrent chemotherapy and the increase of radiotherapy dose. Surgical excision can improve the OS of pancreatic cancer patients.