盐酸吉西他滨联合立体定向放疗治疗局部晚期胰腺癌的临床价值

Clinical effects of stereotactic radiotherapy combined with gemcitabine in treatment of locally advanced pancreatic carcinoma

目的:评价盐酸吉西他滨联合立体定向放疗治疗局部晚期胰腺癌的疗效.方法:118例不能手术切除的胰腺癌患者按治疗方法分为2组:A组盐酸吉西他滨联合立体定向放疗组,共56例,B组单独立体定向放疗组,共62例.立体定向放射治疗,单次剂量2.8-3.5Gy,50%-65%等剂量曲线包绕PTV,总剂量35-45Gy,每周治疗6 d,治疗次数10-13次.A组首程同步化疗,吉西他滨600 mg/m2,放疗开始第1、8天静脉输注,放疗结束后3 wk开始第2周期化疗,吉西他滨1000 mg/m2,21 d为1周期,共治疗4-6周期.结果:2mo后复查计算机断层扫描及磁共振,A组肿瘤病灶治疗有效率67.8%(38/56),中位生存时间12.8mo(范围4-70 mo),1年生存率58.9%(33/56),2年生存率28.6%(16/56).常见不良反应为白细胞、血小板下降及消化系反应.B组肿瘤病灶治疗有效率30.6%(19/62),中位生存时间8.5mo(范围5-56mo),1年生存率33.9%(21/62),2年生存率12.9%(8/62).治疗期间常见不良反应为恶心及呕吐,白细胞下降.盐酸吉西他滨联合立体定向放射治疗组的近期疗效及远期疗效均优于立体定向放疗组.结论:盐酸吉西他滨联合立体定向放疗具有较好的近远期疗效,不良反应能够耐受.

AIM： To evaluate the clinical effects of stereotactic conformal radiotherapy combined with gemcitabine in patients with locally advanced pancreatic carcinoma. METHODS： A total of 118 patients with unresectable locally advanced pancreatic carcinoma were divided into two groups to receive either radiotherapy combined with gemcitabine （group A, 56 cases） or radiotherapy alone （group B, 62 cases）. The standard dose of stereotactic conformal radiotherapy prescribed was 35-45 Gy to the 50%-65% isodose curve. The total dose was delivered over 10-13 d with a fraction dose of 2.8-3.5 Gy and 6 fractions per week. Concomitant chemotherapy started at the first day of radiotherapy： gemcitabine at a dose of 600 mg/m2 was given on days I and 8, and adjuvant chemotherapy was administered three weeks after radiotherapy at a dose of gemcitabine 1000 mg/m2 on days 1 and 8, 21 days per cycle, for 4-6 cycles continuously. RESULTS： The patients underwent CT or MR examination 2 mo after 2 treatment. The tumor response rate of group A was 67.8% （38/56）. Median survival time was 12.8 mo （range, 4-70 mo）. The overall 1-year and 2-year survival rates were 58.9% （33/56） and 28.6% （16/56）, respectively. Main side effects included leukopenia, thrombocytopenia, nausea and vomiting. The tumor response rate of group B was 30.6% （19/62）. Mediansurvival time was 8.5 mo （range, 5-56 too）. The overall 1-year and 2-year survival rates were 33.9% （21/66） and 12.9% （8/62）, respectively. Main side effects were leukopenia and thrombocytopenia. Both the short-term and long-term therapeutic effects were better in the combination group than in the radiotherapy alone group. CONCLUSION： Gemcitabine combined with stereotactic conformal radiotherapy is effective and safe in the treatment of patients with locally advanced pancreatic carcinoma.