Wilkowski Ralf, Thoma Martin, Bruns Christiane, Dühmke Eckhard, Heinemann Volker
Clinic for Radiation Oncology, LMU University Hospital Grosshadern, Munich, Germany.
JOP. 2006 Jan 11;7(1):34-40.
Primary resectability is expected in up to 20% of pancreatic cancer patients. While most patients relapse with distant metastases, approximately 30% of patients show isolated local recurrence without evidence of distant metastases.
The present analysis investigates the efficacy of chemoradiotherapy in this particular patient group.
Retrospective study.
Eighteen consecutive pancreatic cancer patients presenting with isolated locoregional recurrence after surgical resection. The median interval between primary surgery and diagnosis of local recurrence was 10.4 months (range: 2.0-19.3 months).
Patients received 3-D conformal radiation with 45 Gy in 25 fractions of 1.8 Gy/day. Simultaneous chemotherapy was employed either with continuous 5-FU infusion, partly in combination with gemcitabine, or with gemcitabine and cisplatin. Sequential chemotherapy with gemcitabine and cisplatin was given to some patients before and after the chemoradiotherapy.
In 17 of the 18 patients included, radiotherapy was employed at the intended dose. While WHO grade 3-4 gastrointestinal toxicity was not reported, hematotoxicity was more pronounced. Grades 3 and 4 leukocytopenia occurred in 4 patients (22.2%) and 1 (5.6%) patient, respectively, and grades 3 and 4 thrombocytopenia occurred in 4 patients (22.2%) and 1 patient(5.6%), respectively. Six (37.5%) complete remissions, 6 (37.5%) partial remissions, and 4 (25.0%) stable diseases were noted in 16 evaluable patients. Median progression-free survival calculated from the start of the chemoradiotherapy was 14.7 months (range: 8.4-21.0 months) . Seven (28.9%) patients had another local relapse, while 11 (61.1%) patients developed distant metastases. Median overall survival from the start of the chemoradiotherapy was 17.5 months (95% CI: 15.6-19.4 months) and median survival from the initial diagnosis was 27.2 months (95% CI: 23.9-30.6 months).
The data provide a first indication that chemoradiotherapy is feasible and may be an effective treatment option in those patients who present with local metastasis after primary surgery for pancreatic cancer.
预计高达20%的胰腺癌患者可进行初次切除。虽然大多数患者会出现远处转移复发，但约30%的患者表现为孤立性局部复发且无远处转移证据。
本分析研究了放化疗在这一特定患者群体中的疗效。
回顾性研究。
18例连续的胰腺癌患者，在手术切除后出现孤立性局部复发。初次手术与局部复发诊断之间的中位间隔时间为10.4个月（范围：2.0 - 19.3个月）。
患者接受三维适形放疗，剂量为45 Gy，分25次，每天1.8 Gy。同步化疗采用持续5 - 氟尿嘧啶输注，部分联合吉西他滨，或采用吉西他滨和顺铂。部分患者在放化疗前后接受吉西他滨和顺铂序贯化疗。
纳入的18例患者中有17例按预期剂量进行了放疗。未报告世界卫生组织3 - 4级胃肠道毒性，但血液毒性更为明显。3级和4级白细胞减少分别发生在4例（22.2%）和1例（5.6%）患者中，3级和4级血小板减少分别发生在4例（22.2%）和1例（5.6%）患者中。16例可评估患者中，6例（37.5%）完全缓解，6例（37.5%）部分缓解，4例（25.0%）病情稳定。从放化疗开始计算的中位无进展生存期为14.7个月（范围：8.4 - 21.0个月）。7例（28.9%）患者出现另一次局部复发，11例（61.1%）患者发生远处转移。从放化疗开始计算的中位总生存期为17.5个月（95%CI：15.6 - 19.4个月），从初始诊断开始计算的中位生存期为27.2个月（95%CI：23.9 - 30.6个月）。
数据首次表明，放化疗是可行的，对于胰腺癌初次手术后出现局部转移的患者可能是一种有效的治疗选择。
