调强放疗联合口服替吉奥化疗治疗局部进展期胰腺癌的疗效观察

Clinical efficacy of intensity modulated radiotherapy with oral S-1 for locally advanced pancreatic cancer

目的探讨调强放疗联合口服替吉奥化疗治疗局部进展期胰腺癌的疗效及安全性。方法选取42例局部进展期胰腺癌患者，将患者按随机数字表法分为两组，治疗组21例，给予调强放疗的同时替吉奥40mg／m^2每日2次口服，连服2周休息1周为1个疗程，至放疗结束；对照组21例，给予调强放疗的同时吉西他滨1000mg／m^2加入0．9％氯化钠100ml中，30min内静脉滴注，第1，8，22，29天。调强放疗剂量：50．4Gy／28次，5次／周，1．8Gy／次。放疗结束后4周评价近期疗效及不良反应。结果治疗组和对照组有效率和疾病控制率比较差异无统计学意义[57．1％（12／21）比47．6％（10／21）、85．7％（18／21）比76．2％（16／21），P〉0．05]。治疗组中性粒细胞减少和血小板减少发生率明显低于对照组[23．8％（5／21）比57．1％（12／21）、28．6％（6／21）比66．7％（14／21）]，差异有统计学意义（P〈0．05）；两组贫血、恶心、呕吐、转氨酶升高和疲劳发生率比较差异无统计学意义（P〉0.05）。结论调强放疗联合口服替吉奥化疗治疗局部进展期胰腺癌安全有效，值得临床推广。

Objective Toinvestigatethefeasibilityandefilcacyoftheintensitymodulatedradiotherapy （IMRT） with oral S-1 for locally advanced pancreatic cancer. Methods Forty-two patients with locally advanced pancreatic cancer were selected, and the patients were divided into 2 groups by random digits table method with 21 cases each. The patients in treatment group were treated by IMRT combined with oral S-1 40 mg/m^2 twice daily from day 1 to day 14 of a 21-d cycle; the patients in control group were treated by IMRT combined with 30 rain intravenous infusions of gemcitabine 1 000 mg/m^2 on day 1, 8, 21 and 29. Radiation was concurrently delivered at a dose of 50.4 Gy （1.8 Gy/d, 5 times per week, 28 fractions）. The dose of intensity modulated radiotherapy was 1.8 Gy/time （ 5 times/week, 50.4 Gy/28 times）. The recent curative effect and untoward reaction were assessed at the end of radiotherapy after 4 weeks. Results There were no statistical differences in efficient rate and disease control rate between treatment group and control group： 57.1% （12/21） vs. 47.6% （10/21） and 85.7% （18/21） vs. 76.2% （16/21）, P〉 0.05. The neutropenia rate and thrombocytopenia rate in treatment were significantly lower than those in control group： 23.8% （5/21） vs. 57.1% （12/21） and 28.6% （6/21） vs. 66.7% （14/21）, and there were statistical differences （P 〈 0.05）. There were no statistical differences in the incidences of anemia, nausea, vomiting, elevated aminotransferase and fatigue （P〉 0.05）. Conclusions The IMRT with oral S-1 for locally advanced pancreatic cancer is safe and effective. It is worthy of clinical promotion.