立体定向放射治疗联合吉西他滨治疗晚期胰腺癌的临床效果观察

Clinical efficacy observation of stereotactic radiation therapy combined with gemcitabine for advanced pancreatic carcinoma

目的 观察失去手术机会的晚期胰腺癌患者立体定向放射治疗（SRT）联合吉西他滨治疗的临床效果.方法 对24例晚期胰腺癌患者进行了6 MV-X线的SRT联合吉西他滨治疗,利用体部立体定向框架及热塑料体模固定,CT扫描后将图像输入到治疗计划系统中,根据肿瘤靶区、敏感器官和移动误差勾画大体肿瘤靶体积（GTV）、临床靶体积（CTV）、计划靶体积（PTV）,结合剂量-体积直方图（DVH）选择最佳治疗方案,应用5～7个非共面野照射,≥95％等剂量线包绕PTV,并以此为处方线,常规分割,每周5次,每次1.8～2.0 Gy,总剂量（DT） 50～60 Gy.放疗中的第1、2周静脉滴注吉西他滨1 000 mg/m2,每周1次,休息1周后,第4、5周重复.结果 在放、化疗中50.0％（12/24）患者出现轻度恶心,41.7％（10/24）患者出现1～2级白细胞或血小板减少,对症处理后均能耐受.治疗后1～3个月,83.3％（20/24）患者食欲改善;6例黄疸患者全部退黄;腹痛缓解者占87.5％（21/24）,其中3例患者疼痛基本消失.局部肿瘤完全消退者占16.7％（4/24）,部分消退者占66.7％（16/24）,总有效率为83.4％（20/24）.1年生存率为70.8％（17/24）;7例患者因恶病质、肠梗阻或出血于1年内死亡;无生存2年以上者.结论 SRT联合吉西他滨能使失去手术机会的晚期胰腺癌患者症状减轻,生活质量改善和生存期延长,尤其对年老、体弱患者,更适宜选择该方案治疗.

Objective To seek the curative effect of stereotactic radiation therapy （SRT） combined with gemcitabine for unresectable advanced pancreatic carcinoma. Methods 24 patients were treated by SRT of 6MV X-ray. Patients were fixed with the rack of stereotactic localization and heated plastics mould. The CT scanning results were put into the treatment planning system. According to the target area of tumor, sensitive organs and moving error drew GTV, CTV and PTV. The best plan was selected by the dose-volume histogram （DVH）. 5 to 7 beams of non-coplanar radiation ray were chosen. PTV was surrounded by I〉 95 % isodose curves. Conventional fraction, 5 fractions per week, 1.8-2 Gy per fraction was used. All patients received a total dose of 50-60 Gy. Gemcitabine was performed 1000 mg/m2, once a week, iv gtt, in the 1st, 2nd and 4th, 5 th weeks. Results In chemo-radiotherapy, 50.0 % （12/24） patients showed light nausea, 41.7 % （10/24） patients showed leucopenia or thrombocytopenia of grade 1 or 2, after symptomatic treatment, all patients completed the planned treatment. In a period of one month to three months, after SRT combined with chemotherapy, appetite improvement was 83.3 % （20/24）, jaundice disappeared in 6 of 6 patients （100.0 %）, abdominal pain was relieved in 21 of 24 patients （87.5 %）, 3 patients were relieved completely among them. The complete remission （CR） rate was 16.7 % （4/24） and partial remission （PR） rate was 66.7 % （16/24）, with CR＋PR rate of 83.4 % （20/24）. One-year survival rate was 70.8 % （17/24）. As a consequence of cachexia, intestinal obstruction or bleeding, 7 patients died within one year. Nobody survived more than 2 years. Conclusions SRT combined with gemcitabine for advanced pancreatic carcinoma may relieve symptoms. It is an effective approach to improve life quality and prolong survival time for ad^nced pancreatic carcinoma,especially lod and weak patients are more suitable to select SRT combined with gemcitabine.