调强放疗联合替吉奥化疗局部晚期胰腺癌临床观察

Efficacy of IMRT combined with S-1in advanced pancreatic cancer

目的：回顾性研究适形调强放疗（intensitymodulatedradiotherapy，IMRT）联合替吉奥化疗治疗局部晚期胰腺癌的临床资料，探讨IMRT联合替吉奥治疗晚期胰腺癌的临床价值。方法：回顾性分析2005—06—01—2010—06—30第二军医大学附属东方肝胆外科医院收治的74例仅行IMRT治疗及33例IMRT联合替吉奥治疗的晚期胰腺癌患者临床资料及随访结果，对可能影响胰腺癌预后的各种因素进行单因素及多因素分析，比较IMRT组和IMRT＋替吉奥组在不同临床分期的生存情况，以及两组毒副作用发生情况。结果：1）临床分期（RR=1．976，95％CI：1．015～3．847）和替吉奥化疗（RR=0．574，95％CI：0．487～0．930）是影响局部晚期胰腺癌治疗后生存相关因素。2）Ⅲ期患者中，IMRT＋替吉奥组中位生存期（13．6个月）明显高于IMRT组（10．2个月），两组间差异有统计学意义，X2=3．87，P=0．048；Ⅳ期患者中，两组间差异无统计学意义，X2=0．64，P=0．425。3）主要毒副作用为恶心呕吐（P=0．442）、腹痛（P=0．655）、骨髓抑制（P=0．124）、消化道出血（P=0．672）和肝功能受损（P=0．706），两组问差异均无统计学意义。结论：应用IMRT联合替吉奥治疗局部晚期胰腺癌患者疗效显著，无明显的毒副作用增加，对于Ⅲ期患者，同步放化疗可明显提高患者生存期；对于Ⅳ期患者，同步放化疗无明显的生存获益。

OBJECTIVE： To retrospectively study of intensity modulated radiotherapy （IMRT） combined with s-1 chemotherapy in locally advanced pancreatic cancer,and to explore the clinical value of IMRT combined with s-1 in treat- ment of advanced pancreatic cancer. METHODS： We retrospectively analyzed the clinical data and follow-up results of 107 advanced pancreatic carcinoma patients among which 84 eases was treated by IMRT and 33 cases was treated by IMRT combined with S-1 between June, 1,2005 to June,30,2010. The single and multiple factors which may affect the various factors of the prognosis of pancreatic cancer patients were analyzed, and compared the survival situation between two groups in different clinical stages as well as the incidence of toxicity. RESULTS： 1）The clinical stages （RR--l. 976, 95% CI：1. 015--3. 847） and the S-1 chemotherapy （RR=0. 574,95%CI：0. 487--0. 930） was related factors for survival in pancreatic carcinoma after treatment;2）In stage III, the survival rate of the patients in IMRT＋S 1 group was higher than that in control group （P〈0.05） ;which had statistical significance between two groups, but there was no significant difference in stage IV patients. 3）The main side effects include： nausea vomiting（P = 0. 442）, abdominal pain （P= 0. 655） ,myelosuppression （P=0. 124） ,gastrointestinal bleeding （P= 0. 672）, liver dysfunction （P= 0. 706）, and the re- suits were not statistically different between the two groups. CONCLUSION： Concurrent chemoradiotherapy in patients with advanced pancreatic cancer can significantly improve the survival of patients,and do not increased side reactions sig- nificantly.