术后高剂量少分次放疗对胰腺癌患者的影响

Study on the Effect of High-Dose and Fractionated Radiotherapy in Patients with Pancreatic Cancer after Surgery and its Impact on Survival

目的:探讨高剂量少分次放疗模式在胰腺癌术后患者中的应用效果及对患者生存期的影响。方法:选择2015年2月—2018年2月我院收治的胰腺癌患者78例,随机分为对照组(n=39例)和观察组(n=39例)。两组均行手术治疗,对照组术后采用常规化疗方案治疗,观察组在对照组基础上同步高剂量少分次放疗模式治疗,3个疗程后对患者效果进行评估,两组治疗后均完成24个月随访,比较两组近期疗效、生活质量、不良反应发生率及生存率。结果:观察组的有效率为66.67%,高于对照组41.03%,差异有统计学意义(χ2=6.734、P=0.026);观察组治疗后体重减轻(42.41±3.59)、疲倦(31.54±3.26)分、疼痛(19.77±3.61)分、腹胀(35.34±4.11)分、腹泻(13.49±3.13)分及食欲下降评分(28.48±3.59)分均低于对照组[体重减轻(55.79±4.22)、疲倦(45.69±4.12)分、疼痛(32.14±4.03)分、腹胀(43.15±4.25)分、腹泻(18.53±3.69)分及食欲下降评分(38.51±4.31)分],差异有统计学意义(t=6.392、5.416、7.498、6.121、5.983、7.335,P=0.032、0.036、0.022、0.030、0.044、0.023);观察组与对照组治疗过程中白细胞降低、放射性肠炎、放射性皮炎、血小板降低及肝肾功能异常发生率无统计学意义(33.33%vs 38.46%,χ2=1.215,P=0.592);观察组1年生存率69.23%、2年生存率41.03%、PFS(12.59±2.31)月、OS(7.83±1.15)月均长于对照组[1年生存率53.85%、2年生存率30.77%、PFS(6.43±1.04)月、OS(4.36±0.85)月],差异有统计学意义(χ2=6.317、4.926,t=5.637、7.112,P=0.034、0.041、0.029、0.011)。结论:高剂量少分次放疗模式能提高胰腺癌患者术后生活质量,提高患者远期生存率,未增加不良反应发生率,值得推广应用。

Objective To explore the effect of high-dose and fractionated radiotherapy in patients with pancreatic cancer after surgery and its impact on survival.Methods Seventy-eight patients with pancreatic cancer from February 2015 to February 2018 were selected as subjects.The random number method was divided into a control group(n=39 cases)and an observation group(n=39 cases).Both groups underwent surgical treatment.The control group was treated with conventional chemotherapy after operation.The observation group was treated with a high-dose and small-fraction radiotherapy model based on the control group.The effect of the patients was evaluated after 3 courses of treatment.Both groups were completed after treatment.Followed up for 24 months,the short-term efficacy,quality of life,incidence of side effects and survival rate were compared between the two groups.Results The curative effect rate of the 3 treatment courses of the observation group was 66.67%,which was higher than that of the control group 41.03%(χ2=6.734,P=0.026).The weight loss(42.41±3.59)and fatigue(31.54±3.26)of the 3 treatment courses of the observation group after treatment,pain points(19.77±3.61),abdominal distension points(35.34±4.11),diarrhea points(13.49±3.13)and appetite loss score points(28.48±3.59)were lower than those of the control group,which were weight loss(55.79±4.22),fatigue points(45.69±4.12),pain points(32.14±4.03),abdominal distension points(43.15±4.25),diarrhea points(18.53±3.69)and appetite loss score points(38.51±4.31)(t=6.392,5.416,7.498,6.121,5.983,7.335,P=0.032,0.036,0.022,0.030,0.044,0.023).The incidence of leukopenia,radiation enteritis,radiation dermatitis,platelet reduction and abnormal liver and kidney function during the treatment of the observation group and the control group were not statistically significant(occurrence rates were 33.33%vs 38.46%)(χ2=1.215,P=0.592).The observation group had a 12-month survival rate of 69.23%,a 24-month 41.03%survival rate,PFS(12.59±2.31)months and OS survival The period(7.83±1.15)months were longer than those of the control group,which 12-month survival rate 53.85%,24-month 30.77%survival rate,PFS(6.43±1.04)month and OS survival period(4.36±0.85)month(χ2=6.317,4.926,t=5.637,7.112,P=0.034,0.041,0.029,0.011).Conclusion The high-dose,low-fractionated radiotherapy model can be used in patients with pancreatic cancer after surgery to obtain higher short-term efficacy,improve the patient's quality of life after surgery,improve the patient's longterm survival rate,and do not increase the incidence of toxic and side effects.It is worth promoting.