立体定向放疗再程治疗局部晚期复发胰腺癌的疗效分析

Analysis on the therapeutic effects of re-irradiation with stereotactic body radiation therapy for the advanced recurrent locally pancreatic cancer

目的探讨立体定向放疗(SBRT)再程治疗局部晚期复发胰腺癌的安全性和有效性。方法2014年至2017年间上海长海医院收治7例接受两次SBRT的Ⅲ期胰腺癌患者,均采用G4系统射波刀进行治疗,首程SBRT中位剂量为35Gy/5~7fx,再程SBRT治疗中位剂量为31Gy/5~8fx。除1例拒绝化疗外,余6例均接受吉西他滨或者替吉奥为基础的序贯化疗。结果7例患者中男性5例,女性2例,年龄47~70岁,中位总生存期(OS)为30个月,两次SBRT治疗时间间隔中位值为10个月。SBRT再程治疗后的中位OS为13个月,中位局部无复发生存期(LFRS)为11个月。再程治疗后3个月3例(42.9%)部分缓解,4例病情稳定。4例患者SBRT再程治疗结束时疼痛消失,2例患者治疗后1月疼痛明显好转。两次SBRT治疗中7例患者均未出现3级或3级以上的不良事件。结论接受SBRT再程治疗的局部晚期复发胰腺癌患者可耐受不良反应,SBRT再程治疗能够有效缓解疼痛、延长生存时间,提高生活质量。

ObjectiveTo investigate the safety and efficacy of re-irradiation with stereotactic body radiotherapy(SBRT) for treating locally recurrent advanced pancreatic cancer.MethodsFrom 2014 to 2017, 7 patients with stage Ⅲ pancreatic cancer were treated by re-irradiated with SBRT at Shanghai Changhai Hospital. SBRT was delivered via the G4 type cyberknife robotic stereotactic radiosurgery system in all the patients. The median dose of the first SBRT was 35Gy/5-7 fx, and the median dose of re-irradiation with SBRT was 31 Gy/5-8 fx. 6 patients had undergone sequential chemotherapy either with gemcitabine or S-1 based therapy except one patient who refused the chemotherapy.ResultsThere were 5 male and 2 female patients. The median overall survival (OS) of 7 patients was 30 months. Patients were re-irradiated with SBRT after a median interval of 10 months after the first SBRT. Median OS and locally relapse-free survival (LFRS) from re-irradiation were 13 months and 11 months, respectively. Three months after re-irradiation, 3(42.9%) patients had partial remission and 4 patients had stable disease. Pain disappeared in 4 patients at the end of re-irradiation and significant pain was alleviated in 2 patients 1 month after re-irradiation. There were no toxicities of grade 3 or higher grade during two courses of SBRT.ConclusionsFor patient with locally recurrent advanced pancreatic cancer, SBRT re irradiation regimen was associated with acceptable toxicity, which can effectively alleviate the pain, prolong the survival and improve the life quality.