射波刀与伽玛刀治疗局部晚期胰腺癌的比较

Comparison of the efficacy of CyberK nife therapy with Gamma-Knife therapy in patients with locally advanced pancreatic cancer

目的:对比观察射波刀与体部伽玛刀治疗局部晚期胰腺癌的疗效。方法:选取113例局部晚期胰腺癌患者,根据治疗方法的不同将其分为射波刀组(45例)与伽玛刀组(68例),并观察两组的治疗效果、副反应以及随访无进展生存时间和总生存时间。结果:射波刀组和伽玛刀组治疗有效率分别为75.56%和73.53%,疼痛缓解率分别为94.74%和94.52%,中位疼痛缓解时间分别为4 d和16 d。治疗后两组的总胆红素、肿瘤标志物(CA19-9)指标均较治疗前明显改善,治疗前后比较有差异(t=14.22,t=12.94;P<0.05)。中位随访时间28个月,两组中位无进展生存时间(PFS)分别为10.1个月和8.7个月,两组比较有差异(t=10.07,P<0.05),中位生存时间(OS)分别为15.5个月和14.8个月,两组比较无差异(t=2.76,P>0.05)。射波刀组和伽玛刀组患者的消化道反应发生率为48.89%和58.82%,(x^2=2.09,P<0.05),骨髓抑制发生率分别为11.11%和11.76%,两组比较无差异(x^2=5.66,P>0.05),均未见3~4级严重并发症发生。结论:与伽玛刀比较,射波刀治疗局部晚期胰腺癌局部控制率和有效率相似,但可提高无进展生存时间,且疗程短、起效快,不良反应小,是一种更为安全有效的治疗方法。

radiation therapy （Gamma-Knife） in treatment of locally advanced pancreatic cancer. Methods： 113 patients with locally advanced pancreatic cancer were divided into two groups according to receiving therapy method （CyberKnife group and Gamma-Knife group）. Therapeutic effects, side effects, progression-free survival （PFS） and overall survival （OS） were recorded. Results： In the group of CyberKnife and Gamma-Knife, the objective response rate （ORR, CR＋PR） was 75.56%and 73.53%（P〉0.05）, and the rate of pain alleviation was 94.74%and 94.52%（P〉0.05）, respectively. The median time of pain relief was 4 days and 16 days （P〈0.01）. After treatment, the index of total bilirubin and CA19-9 were significantly improved in both of the two groups, but there was no significant difference between them. The median time of follow-up was 28 months. The median PFS and OS in CyberKnife group and Gamma-Knife group were 10.1 and 8.7 months （t=10.07, P〈0.05）, 15.5 and 14.8 months, respectively （t=2.76, P〉0.05）. The rate of gastrointestinal tract side effect and myelosuppression in the two groups were 48.89%and 58.82%, 11.11%and 11.76%, respectively （x2=5.66, P〉0.05）. There was no grade 3-4 serious adverse reaction. Conclusion：Compared with Gamma-Knife therapy, CyberKnife therapy is more effective and safer for patients with advanced pancreatic cancer which can obtain similar local control rate and effective rate. But it can improve the PFS and has the characteristics of short course, fast effect and less adverse reaction.