调强放疗联合卡培他滨同步化疗及HIFU治疗非手术老年胰腺癌患者疗效观察

Efficacy of IMRT Combined with Capecitabine Concurrent Chemotherapy and High Intensity Focused Ultrasound for Elderly Patients with Non-operatable Pancreatic Cancer

目的探讨调强放疗(intensity modulated radiotherapy,IMRT)联合口服卡培他滨同步化疗及高强度聚焦超声(high intensity focused ultrasound,HIFU)治疗非手术老年胰腺癌患者的疗效及不良反应。方法患者60例随机分为对照组和观察组,各30例。对照组行IMRT联合口服卡培他滨同步化疗,于放疗第1天开始给予卡培他滨800~1 000 mg/m^2早晚饭后各口服一次,连续用药14天,休息7天行下一周期化疗,放疗结束后巩固化疗2~4周期。观察组行IMRT联合口服卡培他滨同步化疗及HIFU治疗,化疗方案同对照组,HIFU于放疗第1天开始,5次/周,连用4~6周。结果对照组和观察组治疗前后疼痛评分比较差异有统计学意义(P=0.001,P<0.0001);两组间治疗前后疼痛减轻程度比较,差异有统计学意义(P=0.0162)。对照组和观察组的近期疗效组间比较,差异有统计学意义(Z=-2.159,P=0.031)。对照组和观察组在总生存率、无进展生存率、骨髓抑制、急性放射性肝损伤、急性放射性胃肠道损伤及急性放射性肾脏损伤不良反应发生率以及两组失败模式等方面比较,差异无统计学意义(P>0.05)。结论 IMRT联合卡培他滨同步化疗及HIFU治疗老年非手术胰腺癌可缓解患者疼痛,提高生活质量,近期疗效确切,但未延长患者长期生存。

Objective To explore the clinical efficacy and toxicity of intensity modulated radiotherapy（IMRT） combined with oral capecitabine concurrent chemotherapy and HIFU for elderly patients with nonoperatable pancreatic cancer. Methods Total 60 elderly patients with non-operatable pancreatic cancer were randomly divided into two group, 30 patients in control group received concurrent radiochemotherapy（intensity modulated radiation therapy（IMRT） with 6 MV X-ray and concurrently oral capecitabine（800-1 000 mg/m^2, bid, d1-14, 21 days/cycle, concurrent chemotherapy for two cycles, consolidate chemotherapy for 2-4cycles））, and 30 patients in observation group received same concurrent radiochemotherapy and HIFU carried out concurrently with IMRT（5 days/week, 4-6 weeks）. Results There was significant difference of pain relief score in both control and observation group before and after treatment（P=0.001, P〈0.0001）; the degree of pain releif in the observation group was more than that in the control group（P=0.0162）. The difference of the short-term effects between two groups was statistical（Z=-2.159, P=0.031）. The over survival, progression-free survival, failure patterns and adverse effects, such as myelosuppression, radiation-induced liver disease, radiationinduced gastrointestinal disease and radiation-induced kidney disease, were not statistically different between two groups（P〈0.05）. Conclusion IMRT combined with capecitabine concurrent chemotherapy and HIFU for elderly patients with non-operatable pancreatic cancer are safe and effective in relieving pain and improving the quality of life, but there isn＇t advantage in longer overall survival or longer progression-free survival.