吉西他滨联合替吉奥序贯替吉奥同步放化疗与联合化疗治疗局部晚期胰腺癌比较观察

Comparison of Two Kinds of Comprehensive Treatment in the Locally Advanced Pancreatic Cancer

目的探讨吉西他滨联合替吉奥序贯替吉奥同步放化疗与联合化疗在局部晚期胰腺癌治疗中的临床疗效和安全性。方法 39例诊断明确且无法手术的局部晚期胰腺癌患者在2种综合治疗方式后的生存状况,分为A、B组,其中A组20例,B组19例,A组采用吉西他滨联合替吉奥诱导化疗后序贯同步放化疗,以替吉奥为同步化疗药物;B组采用吉西他滨与替吉奥联合化疗。采用有效率、疾病控制率、临床受益反应来评价近期疗效;远期随访以无进展生存期和总生存期为观察终点,并对药物的安全性进行评估。结果 A组可评估患者16例,B组15例。在完成周期治疗的患者中,A组有效率、疾病控制率均优于B组(分别为31.2%vs 26.7%,81.3%vs 73.3%),差异有统计学意义(P=0.015、0.047)。A组患者总的临床受益反应率高于B组(80.6%vs 72.4%),差异有统计学意义(P=0.035);A组的疼痛评分降低及疼痛改善持续时间明显优于B组,差异有统计学意义(P<0.05);2组体质量增加及KPS评分升高差异无统计学意义(P>0.05)。A组的中位无进展生存期和中位总生存期均略高于B组(5.8个月vs 4.9个月,16.1个月vs 15.3个月),但差异无统计学意义(P=0.423、0.348)。A组的1 a生存率(70.2%)略高于B组(67.9%),但差异无统计学意义(P=0.315)。在血液学毒性反应方面,A组发生率低于B组,差异有统计学意义(P<0.05);在胃肠道反应及肝、肾功能不全方面,A组与B组差异均无统计学意义(P均>0.05)。结论吉西他滨联合替吉奥序贯替吉奥同步放化疗较联合化疗在肿瘤局部控制及疼痛控制方面上更优,但2种综合治疗在提高患者的生存方面效果相近;2种综合治疗的毒副反应均可耐受,其中吉西他滨联合替吉奥序贯替吉奥同步放化疗较联合化疗的血液学毒性稍低。

Objective To compare the clinical efficacy and safety of two comprehensive programs in the treatment of locally advanced pancreatic cancer. Methods Thirty-nine patients with locally advanced pancreatic cancer were divided into the two groups. 20( group A) received gemcitabine and S-1 combined with synchronous radiotherapy and chemotherapy,19( group B) received gemcitabine and S-1. Results The response rate and disease control rate of the group A were higher than the group B( 31. 2% vs 26. 7%,81. 3% vs 73. 3%),which remained statistically significant( P = 0. 015,0. 047). The clinical benefit response was 80. 6% in the group A,and 72. 4% in the group B,there was significantly different in the clinical benefit response( P = 0. 035). The median progression-free survival and the median overall survival of the group A were higher than the group B( 5. 8 months vs 4. 9 months,16. 1 months vs 15. 3 months),but there were no significant difference( P = 0. 423,0. 348). The toxicities in the blood system of the group A were inferior to the group B( P < 0. 05). The others toxicities between the two groups were not significantly different( P > 0. 05). Conclusion Compared with gemcitabine and S-1,gemcitabine and S-1 combined with synchronous radiotherapy and chemotherapy has better disease control and pain control for locally advanced pancreatic cancer,but it can’t improve the survival rate. The toxicities in the blood system of the group A were inferior to the group B,but the others toxicities between the two groups were not significantly different.