上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

117例无远处转移胰腺癌的放疗效果分析

胡斌1，许磊1，白永瑞1，叶明1，孙晓光2，宋少莉2   

  1. 上海交通大学 医学院附属仁济医院1.放疗科，2.核医学科，上海 200127
  • 出版日期:2015-08-28 发布日期:2015-09-30
  • 作者简介:胡斌（1981—）， 男， 住院医师， 硕士; 电子信箱: hubin_rj@126.com。
  • 基金资助:

    国家自然科学基金（81471708， 81101073）

Analysis of therapeutic effect of radiotherapy for 117 pancreatic cancer patients without distant metastasis

HU Bin1, XU Lei1, BAI Yong-rui1, YE Ming1, SUN Xiao-guang2, SONG Shao-li2   

  1. 1.Department of Radiation Oncology, 2.Department of Nuclear Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2015-08-28 Published:2015-09-30
  • Supported by:

    National Natural Science Foundation of China, 81471708, 81101073

PDF (PC)

978

摘要：

目的  研究比较无远处转移的胰腺癌患者单独或联合使用三维适形放疗、γ射线立体定向放疗等放疗技术的安全性及疗效。方法  对117例无远处转移的胰腺癌患者，分别给予单纯三维适形放疗（34例）、单纯γ射线立体定向放疗（22例）及三维适形放疗后联合γ射线立体定向放疗（61例）。观察患者的放疗反应以及疗效。结果  放疗后患者临床症状改善，疼痛缓解率为82.1％（64/78）。全组中位生存时间10.1个月，1年生存率为39.9％。单纯三维适形放疗、单纯γ射线立体定向放疗及三维适形放疗后联合γ射线立体定向放疗的患者，中位生存时间分别为7.5、10.3和12.4个月。与单纯三维适形放疗比较，三维适形放疗后联合γ射线立体定向放疗的疗效更佳，中位生存时间分别为7.5个月和12.4个月，1年生存率分别为22.7％和49.9％（χ2=3.300，P=0.069）。放疗前卡氏量表(KPS)评分高（≥90分）、胰腺体尾部肿瘤、肿瘤分期T1～3、放疗前CA19-9＜150 U/mL以及肿瘤体积＜100 cm3的患者预后更佳，均是独立的预后因素。结论  放疗可以明显改善不能手术的无远处转移的胰腺癌患者的生活质量，延长患者的生存时间。对不能手术的无远处转移的胰腺癌患者，三维适形放疗后联合立体定向放疗较传统治疗的效果更佳。

关键词: 胰腺癌；三维适形放疗；&gamma, 射线立体定向放疗

Abstract:

Objective  To explore and compare the safety and outcome between separate usage of three-dimensional conformal radiotherapy or γ ray stereotactic body radiotherapy or combined usage of three-dimensional conformal radiotherapy and γ ray stereotactic body radiotherapy for pancreatic cancer patients without distant metastasis. Methods  A total of 117 pancreatic cancer patients without distant metastasis were enrolled. Among them, 34 patients underwent three-dimensional conformal radiotherapy, 22 patients underwent γ ray stereotactic body radiotherapy, and 61 patients underwent γ ray stereotactic body radiotherapy after three-dimensional conformal radiotherapy. The responses of patients towards radiotherapy and the outcome of radiotherapy were observed. Results  The clinical symptoms of patients were alleviated after radiotherapy and the pain relief rate was 82.1% (64/78). The median survival time (MST) of all patients was 10.1 months and the one-year survival rate was 39.9%. MSTs of patients who underwent three-dimensional conformal radiotherapy, γ ray stereotactic body radiotherapy, and γ ray stereotactic body radiotherapy after three-dimensional conformal radiotherapy were 7.5, 10.3, and 12.4 months, respectively. The outcome of patients who underwent γ ray stereotactic body radiotherapy after three-dimensional conformal radiotherapy was better than that of patients who underwent three-dimensional conformal radiotherapy, and the MSTs were 12.4 and 7.5 months and one-year survival rates were 49.9% and 22.7%, respectively (χ2=3.300, P=0.069). The prognosis of patients with high KPS scores before radiotherapy (≥90), tumors located in pancreatic tail, tumor staging were T1-T3, CA19-9 level was less than 150 U/mL before radiotherapy, and gross tumor volume (GTV) was smaller than 100 cm3 was better. These factors were all independent prognostic factors. Conclusion  Radiotherapy can significantly improve the life quality of pancreatic cancer patients without distant metastasis who are unable to undergo operations and extend their survival time. For these patients, the outcome of γ ray stereotactic body radiotherapy after three-dimensional conformal radiotherapy is better than traditional treatment.