Yamazaki Hideya, Nishiyama Kinji, Koizumi Masahiko, Tanaka Eiichi, Ioka Tatsuya, Uehara Hiroyuki, Iishi Hiroyasu, Nakaizumi Akihiko, Ohigashi Hiroaki, Ishikawa Osamu
Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan.
Strahlenther Onkol. 2007 Jun;183(6):301-6. doi: 10.1007/s00066-007-1641-1.
To examine the feasibility of concurrent use of full-dose gemcitabine (GEM) and radiotherapy for advanced pancreatic cancer.
22 patients with advanced pancreatic cancer were subjected to concurrent chemoradiotherapy (GEM 1,000 mg/m(2) weekly, three times during 4 weeks). They received limited-field irradiation by three-dimensional radiotherapy planning.
Of the 22 patients, 16 (72%) completed the treatment (50 Gy irradiation and at least three times concurrent administration of 1 g/m(2) GEM). One patient with unresectable tail cancer showed peritonitis carcinomatosa and both chemotherapy and radiotherapy had to be stopped. Dose reduction or omission of GEM was necessary in another four patients. In addition, radiotherapy was discontinued in one patient for fatigue. Grade 3 hematologic toxicity was detected in eight patients (36%), and grade 3 nonhematologic toxicity (anorexia) in one patient (5%). In total, the response rate amounted to 32% (seven partial responses), and the median survival time (MST) was 16 months. Among the twelve patients who received preoperative chemoradiotherapy, nine underwent surgery and showed a survival rate of 78% at 1 year. Another 13 patients without surgery showed 14 months of MST. No regional lymph node failure has appeared so far.
Limited-field radiotherapy enables the safe concurrent administration of 1,000 mg/m(2) GEM.
探讨全剂量吉西他滨（GEM）与放疗同步用于晚期胰腺癌的可行性。
22例晚期胰腺癌患者接受同步放化疗（GEM 1000mg/m²，每周1次，共4周3次）。通过三维放疗计划进行限野照射。
22例患者中，16例（72%）完成治疗（照射50Gy且至少3次同步给予1g/m² GEM）。1例无法切除的胰尾癌患者出现癌性腹膜炎，放化疗均被迫停止。另外4例患者需要减少GEM剂量或中断给药。此外，1例患者因疲劳停止放疗。8例患者（36%）出现3级血液学毒性，1例患者（5%）出现3级非血液学毒性（厌食）。总有效率为32%（7例部分缓解），中位生存时间（MST）为16个月。12例接受术前同步放化疗的患者中，9例接受手术，1年生存率为78%。另外13例未接受手术的患者MST为14个月。目前尚未出现区域淋巴结转移。
限野放疗能够安全地同步给予1000mg/m² GEM。
