局部进展期胰腺癌调强放疗剂量递增临床研究

Clinical Trial of Dose Escalation with Intensity Modulated Radiation Therapy in Local Advanced Pancreatic Cancer

目的探索调强放射治疗 (IMRT)提高进展期胰腺癌局部肿瘤靶区剂量以及减少周围正常组织照射剂量的可能性。 方法 2 1例局部进展期胰腺癌患者接受同期放化疗。放射治疗分第一阶段予常规放射治疗 ,剂量30Gy/ 15次 / 3周 ;第二阶段强调放射治疗 ,肿瘤靶区分割剂量 3Gy/次 ,总剂量为 2 1～30Gy ,在 2周内分 7～10次完成。总剂量递增水平 :5 1、5 4、5 7、6 0Gy。在放射治疗过程中 ,每个治疗日 5 -FU静脉点滴。 结果 16例完成治疗计划 ,分别为 5 1Gy 3例、5 4Gy 3例、5 7Gy 3例 ,6 0Gy 7例。 13例治疗前CA19- 9值升高 ,中位值治疗前后分别为 716、2 5 5U/ml(P <0 .0 0 1)。 14例以疼痛为主的患者至少减少 1/ 3～1/ 2的麻醉药品用量 ,其中 5例疼痛症状完全消失。10例患者治疗后卡氏评分有提高。 结论局部进展期胰腺癌患者接受适形调强放疗并同期应用 5 -Fu化疗增敏 ,可获得确切的姑息治疗作用 ,肿瘤剂量 6 0Gy分 2 5次在 5周完成 。

Objective The purpose of this study was to explore whether intensity modulated radiation therapy (IMRT) can increase the dose to the gross tumor volume without severe radiation related toxi city and decrease the dose to the surrounding normal tissue in patients with local advanced pancreatic can cer . Methods Twenty-one patients with local advanced pancreatic cancer were evaluated in this trial. The dose of IMRT from 21Gy to 30Gy in 7 to 10 fractions within two weeks was given after conventional radiotherapy of 30Gy in 15 fractions over 3 weeks. The total escalation tumor dose would be 51, 54, 57, 60Gy. 5-fluororacil (5-FU) was given on the day of radiotherapy during the treatment course. Results Sixteen patients who had completed the radiotherapy plan of 51Gy( n =3), 54Gy( n =3), 57Gy( n =3), 60Gy( n =3) were included for evaluation. The median levels of CA19-9 prior to and after radiotherapy were 716U/ml and 255U/ml respectively ( P <0.001) in 13 patients who demonstrated a high level of CA19-9 before radiotherapy. Fourteen patients who suffered from pain could reduce at least 1/3～1/2 amount of analgesic intake in 5 patients with complete pain-relief and 10 patients improved in Karnofsky performance status . Conclusion IMRT of 60Gy in 25 fractions over 5 weeks combined with 5-FU chemotherapy could provide definite palliative benefit with tolerable acute radiation related toxicity for patients with advanced pancreatic cancer.