局部晚期胰腺癌聚焦大分割适形放疗的临床分析

Clinical Analysis of Focused Large Segmentation Conformal Radiotherapy for Locally Advanced Pancreatic Cancer

目的探讨大分割放疗在局部晚期胰腺癌的可行性,疗效和毒副作用。方法收集我院2010年11月~2015年12月39例Ⅲ、Ⅳ期胰腺癌采用聚焦三维适形放疗,单次照射剂量3 Gy,5次/周,总剂量51 Gy/17 F,靶区中心BED=72 Gy。同期给予吉西他滨500~750 mg/m2,第1天静脉滴注,1次/周,直至放疗结束后继续两周期。结果 39例均全部完成放化疗计划,治疗后缓解腹背部疼痛的总有效率84.26%(27/32),完全缓解率47.15%(15/32),部分缓解率39.31%(12/32),肿瘤退缩率74.72%(29/39)。中位生存期12.8个月,1年生存率62.45%(24/39),2年生存率23.30%(9/39)。主要不良反应为白细胞,血小板减少,恶心、呕吐和肝功能损伤,未发生4级不良反应。结论聚焦大分割适形放疗同步化疗治疗局部晚期胰腺癌有明显的肿瘤杀伤作用,提高患者的生活质量,不良反应可耐受,疗效肯定。

Objective To investigate the feasibility, efficacy and side effects of large segmentation radiotherapy in locally advanced pancreatic cancer.Methods From November 2010 to December 2015,39 patients with stage III and IV pancreatic cancer were treated with focused three-dimensional conformal radiotherapy.The single dose was 3 Gy,5 times/week,and the total dose was 51 Gy/17 F.Center BED=72 Gy.Gemcitabine was given 500-750 mg/m2 in the same period,and the first day of intravenous infusion,1 time/week,continued until two cycles after the end of radiotherapy.Results All the 39 patients completed the radiochemotherapy program.The total effective rate of relief of abdominal pain after treatment was 84.26%（27/32）,the complete remission rate was 47.15%（15/32）,and the partial remission rate was 39.31%（12/32）.The tumor retraction rate was 74.72%（29/39）.The median survival time was 12.8 months,The 1-year survival rate was 62.45%（24/39）,and the 2-year survival rate was 23.30%（9/39）.The main adverse reactions were white blood cells,thrombocytopenia,nausea,vomiting, and liver function damage.No grade 4 adverse reactions occurred. Conclusion Focusing on large segmentation conformal radiotherapy combined with chemotherapy for local advanced pancreatic cancer has obvious tumor killing effect,improve patients’ quality of life,and can tolerate adverse reactions.