Kokubo M, Nishimura Y, Shibamoto Y, Sasai K, Kanamori S, Hosotani R, Imamura M, Hiraoka M
Department of Therapeutic Radiology and Oncology, Graduate School of Medicine, Kyoto University, Sakyo, Kyoto, Japan.
Int J Radiat Oncol Biol Phys. 2000 Nov 1;48(4):1081-7. doi: 10.1016/s0360-3016(00)00673-8.
To determine the survival of pancreatic cancer patients treated with intraoperative radiotherapy (IORT) and/or external beam radiation therapy (EBRT) following macroscopically curative resection.
One hundred and thirty-eight patients with pancreatic cancer who had undergone potentially curative total or regional pancreatectomy between 1980 and 1997 were retrospectively analyzed. Among the 138 patients, 98 had a pathologically negative surgical margin and the remaining 40 patients had a positive surgical margin. The usual EBRT dose was 45-55 Gy with a daily fraction of 1.5-2.0 Gy. The median IORT dose was 25 Gy in a single fraction.
The 2-year cause-specific survival rate of patients with pathologically negative surgical margins was 19%, and that of patients with positive margins was 4% (p < 0.005). Although the median survival time (MST) of patients with negative margins treated with IORT and EBRT was significantly longer than that of those treated with operation alone (17 vs. 11 months), no significant difference in survival curves was observed. In patients with positive surgical margins in peripancreatic soft tissue, the difference between the survival curve of patients treated with surgery alone and that of those treated with surgery and radiation therapy was borderline significant (p < 0.10). Patients receiving intraarterial or intraportal infusion chemotherapy had significantly improved survival rates compared with those who did not receive it (p < 0.05).
Although the MST was longer in patients with negative margins receiving IORT and EBRT than in those receiving no radiation, improved long-term survival by IORT and/or EBRT was not suggested. In patients with positive margins, our results obtained by IORT/EBRT were encouraging. Randomized studies with much higher patient numbers are necessary to define the role of IORT in curatively resected pancreatic cancer.
确定在进行宏观上的根治性切除术后接受术中放疗（IORT）和/或外照射放疗（EBRT）的胰腺癌患者的生存率。
回顾性分析了1980年至1997年间138例接受了可能根治性全胰腺或区域性胰腺切除术的胰腺癌患者。在这138例患者中，98例手术切缘病理检查为阴性，其余40例患者手术切缘为阳性。常规EBRT剂量为45 - 55 Gy，每日分次剂量为1.5 - 2.0 Gy。IORT的中位剂量为单次25 Gy。
手术切缘病理检查为阴性的患者2年病因特异性生存率为19%，切缘阳性患者为4%（p < 0.005）。虽然接受IORT和EBRT治疗的切缘阴性患者的中位生存时间（MST）明显长于单纯接受手术治疗的患者（17个月对1个月），但生存曲线未观察到显著差异。在胰腺周围软组织切缘阳性的患者中，单纯手术治疗患者的生存曲线与手术联合放疗患者的生存曲线之间的差异接近显著（p < 0.10）。接受动脉内或门静脉内灌注化疗的患者与未接受者相比，生存率有显著提高（p < 0.05）。
虽然接受IORT和EBRT治疗的切缘阴性患者的MST比未接受放疗的患者长，但未显示IORT和/或EBRT能提高长期生存率。对于切缘阳性的患者，我们通过IORT/EBRT获得的结果令人鼓舞。需要进行更大样本量的随机研究来确定IORT在根治性切除的胰腺癌中的作用。
