摘要
背景与目的:胰腺癌术后辅助治疗方案目前尚无定论,通过观察胰腺癌患者术后辅助性放疗联合化疗的总生存期(overall survival,OS)、无远处转移生存期(metastasis-free survival,MFS)及不良反应,分析影响MFS的预后因素,明确辅助性放化疗的作用。方法:回顾性分析复旦大学附属肿瘤医院于2011年12月—2018年6月收治的88例胰腺癌R0根治术后患者的临床资料。患者接受了术后辅助性放疗联合化疗,包括区域动脉灌注化疗(regional intra-arterial infusion chemotherapy,RIAC)和系统化疗,中位放疗剂量50.4 Gy,常规分割照射(1.8~2.0 Gy/次)。评估患者治疗相关不良反应及失败模式,并对可能影响MFS的预后因素进行单因素和多因素分析。结果:患者中位OS及MFS分别为27.0及19.9个月,1、3及5年OS率分别为85.1%、30.4%及24.6%;1、3年MFS率为77.5%、28.0%。患者对于放化疗耐受较好,3~4级不良反应主要为血液学毒性,无4级非血液学毒性及5级不良反应发生。58例患者发生远处转移,肝转移最为多见。单因素分析术后辅助性放疗联合RIAC患者较未联合RIAC显示出更好的MFS(25.4个月vs 14.9个月,P=0.036)。多因素分析显示,RIAC是MFS的保护性因素(HR=1.888,P=0.048)。术后辅助性放疗联合RIAC显示出降低肝转移率的趋势。结论:胰腺癌术后辅助性放疗联合化疗是安全的,疗效令人鼓舞。治疗失败以远处转移为主,肝转移多见。术后放疗联合RIAC能够明显改善患者的MFS,可作为胰腺癌术后综合治疗的一种模式。
Background and purpose: Until now, treatment regimen following R0 resection in pancreatic cancer patients is uncertain. The aim of this study was to evaluate the efficacy and toxicity of adjuvant radiotherapy in combination with chemotherapy, and the prognostic factors for metastasis-free survival(MFS) in the setting of multidisciplinary approach strategies. Methods: Eighty-eight patients with pancreatic cancer after R0 resection treated in Fudan University Shanghai Cancer Center from Dec. 2011 to Jun. 2018 were included in the analysis. They were treated with adjuvant radiotherapy at a median dose of 50.4 Gy given by 1.8-2.0 Gy/fraction to the tumor bed and elective nodal regions. The adjuvant chemotherapy included systematic chemotherapy and regional intra-arterial infusion chemotherapy(RIAC). Systematic chemotherapy was administered to all of 88 patients, and RIAC to 63 of 88 patients. Toxicity and patterns of failure were evaluated. Univariate and multivariate analyses were conducted to investigate the prognostic factors for MFS. Results: The patients tolerated the treatment well with 3.4% of Grade 1, 12.5% of Grade 2, 60.2% of Grade 3 and 23.9% of Grade 4 toxicities, respectively. At the last follow-up visit, failures were found in 68 patients, including 58 distant metastases. Among them, the liver was the most common site(23/88). The median overall survival(OS) and MFS were27.0 and 19.9 months, 1-, 3-and 5-year OS rates were 85.1%, 30.4% and 24.6%, and 1-and 3-year MFS were 77.5% and 28.0%, respectively. Univariate analysis revealed that adjuvant radiotherapy combined with RIAC was significantly associated with longer MFS compared with adjuvant radiotherapy without RIAC(25.4 months vs 14.9 months, P=0.036), and RIAC was also confirmed as the independent favorable factor for longer MFS by multivariate analysis(P=0.048). Conclusion: The combination of adjuvant radiotherapy and chemotherapy was safe, and yielded encouraging efficacy for R0 resected pancreatic cancer. Patterns of treatment failure were dominated by distant metastasis, and liver was the most common site of metastasis. Adding RIAC to the combination therapy further improved the MFS, and could be integrated into the adjuvant chemoradiotherapy.
作者
张晓萌
麻宁一
祝鸿程
艾沓杉
任志刚
ZHANG Xiaomeng;MA Ningyi;ZHU Hongcheng;AI Dashan;REN Zhigang(Department of Radiation Oncology,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China;Department of Radiation Oncology,Shanghai Proton and Heavy Ion Center,Shanghai 201315,China)
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2020年第7期519-524,共6页
China Oncology
关键词
胰腺癌
辅助性放疗
区域动脉灌注化疗
无远处转移生存期
Pancreatic cancer
Adjuvant radiotherapy
Regional intra-arterial infusion chemotherapy
Metastasis-free survival