全身γ刀治疗中晚期胰腺癌的研究进展

Efficacy and toxicity of γ-ray stereotactic body radiation therapy in management of locally advanced pancreatic carcinoma: Our experience with 65 cases

AIM: To evaluate the efficacy and toxicity of γ-ray stereotactic body radiation therapy in the management of locally advanced pancreatic carcinoma, and to analyze factors affecting prognosis of locally advanced pancreatic carcinoma.

METHODS: Sixty patients with locally advanced pancreatic carcinoma who were treated with the γ-ray stereotactic body radiation therapy in our department were prospectively enrolled. Depending on tumor size, a total dose of 45-51 Gy was delivered at 3-5 Gy/fraction over 2-3 wk in 5 fractions per week to the 50% isodose line covering the planning target volume. Survival and prognostic factors were analyzed using the Kaplan-Meier method and Cox proportional hazard model, respectively. Univariate and multivariate analyses were performed to examine factors affecting clinical outcome.

RESULTS: Of all lesions, 15 (23%) completely disappeared, and 31 (48%) had a partial response. The total response rate was 71%. The overall 1-year survival rate was 52.4% and the median survival time was 13 mo. All patients tolerated the treatment well and completed the planned therapy. Grade  Ⅰ  acute gastrointestinal toxicity developed in 33 (51%) patients, and grade Ⅱ gastrointestinal toxicity was observed in 12 (18%) patients. Eighteen (28%) patients were diagnosed with grade  Ⅰ  leukocytopenia, and 5 (8%) patients had grade Ⅱ leukocytopenia. Multivariate analysis demonstrated that TNM stage and CA199 ≥ 425.8 U/mL were independent prognostic factors for pancreatic cancer.

CONCLUSION: γ-ray stereotactic body radiation therapy can result in a good curative effect and local control in the treatment of locally advanced pancreatic cancer. No severe adverse events occurred. TNM stage and CA199 ≥ 425.8 U/mL are independent prognostic factors for locally advanced pancreatic carcinoma.