高剂量术中放疗治疗不可切除胰腺癌

High-dose intraoperative radiotherapy for unresectable pancreatic cancer.

作者信息

Shibamoto Y, Manabe T, Ohshio G, Sasai K, Nishimura Y, Imamura M, Takahashi M, Abe M

机构信息

Department of Radiology, Faculty of Medicine, Chest Disease Research Institute, Kyoto University, Japan.

出版信息

Int J Radiat Oncol Biol Phys. 1996 Jan 1;34(1):57-63. doi: 10.1016/0360-3016(95)00014-3.

DOI:10.1016/0360-3016(95)00014-3

PMID:12118565

Abstract

PURPOSE

The results of high-dose intraoperative radiotherapy (IORT) and/or external beam radiotherapy (EBRT) for unresectable pancreatic cancer were analyzed to evaluate the possible advantages of IORT in combination with EBRT.

METHODS AND MATERIALS

Between 1983 and 1993, 115 patients with unresectable adenocarcinoma of the pancreas (53 with non-Stage IV disease and 62 with Stage IV disease) were treated with EBRT + IORT (55 patients), EBRT alone (44 patients), or IORT alone (16 patients). In non-Stage IV patients, the use of EBRT alone was due to the unavailability of IORT and the use of IORT alone was due to refusal of EBRT. The IORT dose was 30-33 Gy and the EBRT dose was 40-60 Gy. A historical control group comprised of 101 patients undergoing palliative surgery alone was also analyzed.

RESULTS

Both non-Stage IV and Stage IV patients receiving EBRT with or without IORT had a better prognosis than the nonirradiated historical controls. Among non-Stage IV patients, the median survival of the EBRT + IORT group (8.5 months) and the EBRT group (8 months) was similar, although survival from 12 to 18 months was higher in the former group (38% vs. 10% at 12 months, p = 0.018, and 19% vs. 0% at 18 months, p = 0.023). In Stage IV patients, the prognosis was not influenced by the type of radiotherapy. Multivariate analysis revealed that a pretreatment carbohydrate antigen (CA) 19-9 level < 1000 U/ml was associated with better survival. In non-Stage IV patients with a CA 19-9 level < 1000 U/ ml, EBRT + IORT appeared to produce a better survival than EBRT alone (p = 0.047). This was supported by multivariate analysis.

CONCLUSION

High-dose IORT + EBRT may be more effective than EBRT alone in patients with unresectable but localized pancreatic cancer and a low CA 19-9 level.

摘要

目的

分析大剂量术中放疗（IORT）和/或外照射放疗（EBRT）治疗无法切除的胰腺癌的结果，以评估IORT联合EBRT的潜在优势。

方法和材料

1983年至1993年间，115例无法切除的胰腺腺癌患者（53例非IV期疾病患者和62例IV期疾病患者）接受了EBRT + IORT治疗（55例）、单纯EBRT治疗（44例）或单纯IORT治疗（16例）。在非IV期患者中，单纯使用EBRT是因为无法进行IORT，而单纯使用IORT是因为患者拒绝EBRT。IORT剂量为30 - 33 Gy，EBRT剂量为40 - 60 Gy。还分析了一个由101例仅接受姑息性手术的患者组成的历史对照组。

结果

接受EBRT联合或不联合IORT的非IV期和IV期患者的预后均优于未接受放疗的历史对照组。在非IV期患者中，EBRT + IORT组（8.5个月）和EBRT组（8个月）的中位生存期相似，尽管前一组12至18个月的生存率更高（12个月时为38%对10%，p = 0.018；18个月时为19%对0%，p = 0.023）。在IV期患者中，放疗类型对预后无影响。多因素分析显示，治疗前糖类抗原（CA）19 - 9水平<1000 U/ml与更好的生存率相关。在CA 19 - 9水平<1000 U/ml的非IV期患者中，EBRT + IORT似乎比单纯EBRT产生更好的生存率（p = 0.047）。多因素分析支持了这一点。