射频消融联合放化疗治疗不可切除的局部进展期胰头癌疗效及安全性分析

Efficacy and safety of radiofrequency ablation combined with concurrent radiotherapy and chemotherapy for locally unresectable carcinoma of pancreas

目的:评估术中冷循环射频消融联合放化疗治疗不可切除的局部进展期胰头癌的疗效和安全性,以及对患者生存质量的影响。方法:对28例不可切除的局部进展期胰头癌患者行术中冷循环射频消融联合放化疗治疗,观察患者手术前后肿瘤标志物CA19-9水平、影像学变化及术后并发症和生存率。结果:本组患者无手术死亡,术后联合放化疗患者均耐受良好。所有患者CA19-9水平明显下降,术后30天、90天彩超和CT在原发病灶未发现肿瘤进展。85.71%(24/28)并发少量胰瘘,分别经引流后愈合,平均引流时间为15天。全组28例随访率为100%,随访时间最长18个月,存活12个月以上23例,最长者已达18个月。其中6个月无进展生存20例,12个月无进展生存13例。结论:开腹下冷循环射频消融联合同期放化疗治疗不可切除的局部进展期胰头癌安全有效,术后患者无进展生存期及生存质量明显提高。

Objective：To evaluate the efficacy of intra-operative radiofrequency ablation combined with concurrent radiotherapy and chemotherapy in the treatment of unresectable pancreatic cancer.Methods：All 28 patients with locally unresectable carcinoma of the pancreas underwent intra-operative radiofrequency ablation combined with concurrent radiotherapy and chemotherapy.Improvements in symptoms,quality of life,complications and survival rates were observed.The changes of imaging and CA19-9 level were recorded.Results：No operation death occurred in this group of patients.Concurrent radiotherapy and chemotherapy was well tolerated.The patient＇s pain and pruritus symptoms were well relieved after operation.The level of CA19-9 decreased after RFA.Color Doppler ultrasound and CT showed no tumor recurrence in the original area after operation for 30 and 90 days.85.71%（ 24 /28） patients occurred concurrent pancreatic fistula lightly,which were healed after drainage.The follow-up rate was 100%.The longest follow-up period was 18 months.23 cases survived more than 12 months and the longest have lived 18 months.The rate of progression free survival（ PFS） for 6 months was 71.43%（ 20 /28）,and 46.43%（ 13 /28） for 12 months.Conclusion：Intra-operative radiofrequency ablation combined with concurrent radiotherapy and chemotherapy for the locally unresectable carcinoma of the pancreas is safe and effective.The patients＇ quality of life and the rate of PFS were improved obviously after operation.