图像引导体部伽玛刀治疗中晚期胰腺癌研究

Clinical study of IGγ-SBRT for advanced pancreatic cancer

目的:评估图像引导体部伽玛刀(IGγ-SBRT)治疗中晚期胰腺癌的临床效果及安全性。方法:选取2017年2月至2020年9月解放军总医院第五医学中心肿瘤医学部(第六医学中心肿瘤科)收治的56例中晚期胰腺癌患者,所有患者均采用IGγ-SBRT治疗,50%~60%等剂量曲线覆盖计划靶体积(PTV),单次周边剂量3.0~4.5 Gy,治疗10~11次,随访并评价治疗效果,采用视觉模拟量表(VAS)评分,评估患者治疗前和治疗后3个月疼痛情况及不良反应。结果:56例患者中52例出现上腹部疼痛,VAS评分为3~10分,其中32例患者伴有腰背部疼痛及腹胀等症状,治疗后3个月复查并随访,VAS评分在原有评分基础上下降3分及以上的患者共48例,疼痛治疗有效率92.3%;有3例患者的VAS评分在原有评分基础上下降1~2分,占疼痛总人数的5.8%。56例患者均在治疗后3个月复查,其中完全缓解(CR)13例,部分缓解(PR)37例,进展(PD)1例,稳定(SD)5例,客观有效率(ORR)为89.3%,局部控制率为98.2%。中位无进展生存期(PFS)为6.5个月,1年生存率为62.5%(35/56),2年生存率为23.2%(13/56)。56例患者不良反应为消化系统反应和血液系统反应,其中47例出现上消化道反应,不良反应发生率为83.9%(47/56),43例出现骨髓抑制,骨髓抑制发生率为76.8%(43/56)。结论:IGγ-SBRT可有效缓解转移性胰腺癌症状,提高治疗有效率、局部控制率和生存率,不良反应耐受性良好,安全性高。

Objective:To assess the clinical efficacy and safety of image-guidedγ-ray stereotactic body radiation therapy(IGγ-SBRT)in treating advanced pancreatic cancer.Methods:A total of fifty-six patients with advanced pancreatic cancer admitted to Senior Department of Oncology Medicine of the Fifth Medical Center of Chinese PLA General Hospital(Department of Oncology of the Sixth Medical Center)from February 2017 to September 2020 were selected.All patients were treated with IGγ-SBRT,and the 50%-60%of isodose curve covered the planned target volume(PTV).The peripheral dose of each time was 3.0-4.5 Gy,and there were 10-11 times of treatment.The therapeutic effect was observed and was evaluated by follow-up.The visual analog scale(VAS)score was adopted to assess the situation of the pain of patients before and 3 months after treatment,and the adverse reaction of them.Results:In the 56 patients,52 cases occurred epigastric pain with VAS ranging from 3 to 10 points,among which 32 patients accompanied by symptoms such as lower back pain and abdominal distension.After 3 months of treatment,the results of reexamination and follow-up indicated that there were 48 patients whose VAS scores decreased 3 scores and above 3 scores on the basis of original scores,and the efficiency of treating pain was 92.3%.In addition,the VAS scores of 3 patients decreased 1-2 scores on the basis of original scores,which ratio was 5.85%of the total number of people.All 56 patients were reexamined at the 3rd month after treatment,and 13 cases of them obtained complete response(CR),and 37 cases obtained partial response(PR),and 1 case obtained progressive disease(PD),and 5 cases obtained stable disease(SD),and the objectively response rate(ORR)was 89.3%,and the locally control rate was 98.2%.In addition,median progression-free survival(PFS)was 6.5 months,and 1-year survival rate was 62.5%(35/56),and 2-year survival rate was 23.2%(13/56).The adverse reactions of 56 patients were the adverse reactions of digestive system and blood system,among which 47 patients occurred upper digestive tract reaction,and the incidence of adverse reactions was 83.9%(47/56).A total of 43 patients occurred myelosuppression,and the incidence of myelosuppression was 76.8%(43/56).Conclusion:IGγ-SBRT can effectively relieve the symptoms of metastatic pancreatic cancer,and improve the effectiveness of treatment,the local control rate and survival rate.The tolerance of adverse reaction of that is favorable,and the safety of that is higher.