Department of Radiation Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
Int J Radiat Oncol Biol Phys. 2010 Nov 1;78(3):735-42. doi: 10.1016/j.ijrobp.2009.08.046. Epub 2010 Feb 18.
Patients with nonmetastatic locally advanced unresectable pancreatic cancer have a dismal prognosis. Conventional concurrent chemoradiotherapy requires 6 weeks of daily treatment and can be arduous. We explored the safety and effectiveness of a 3-day course of hypofractionated stereotactic body radiotherapy (SBRT) followed by gemcitabine in this population.
A total of 36 patients with nonmetastatic, locally advanced, unresectable pancreatic cancer with ≥12 months of follow-up were included. They received three fractions of 8, 10, or 12 Gy (total dose, 24-36 Gy) of SBRT according to the tumor location in relation to the stomach and duodenum, using fiducial-based respiratory motion tracking on a robotic radiosurgery system. The patients were then offered gemcitabine for 6 months or until tolerance or disease progression.
With an overall median follow-up of 24 months (range, 12-33), the local control rate was 78%, the median overall survival time was 14.3 months, the median carbohydrate antigen 19-9-determined progression-free survival time was 7.9 months, and the median computed tomography-determined progression-free survival time was 9.6 months. Of the 36 patients, 28 (78%) eventually developed distant metastases. Six patients (17%) were free of progression at the last follow-up visit (range, 13-30 months) as determined by normalized tumor markers with stable computed tomography findings. Nine Grade 2 (25%) and five Grade 3 (14%) toxicities attributable to SBRT occurred.
Hypofractionated SBRT can be delivered quickly and effectively in patients with nonmetastatic, locally advanced, unresectable pancreatic cancer with acceptable side effects and minimal interference with gemcitabine chemotherapy.
患有局部晚期不可切除的非转移性胰腺癌的患者预后极差。常规的同期放化疗需要 6 周的每日治疗，而且可能很艰难。我们探索了在这一人群中使用 3 天疗程的低分割立体定向体部放射治疗（SBRT）联合吉西他滨的安全性和有效性。
共纳入 36 例有 12 个月以上随访的非转移性、局部晚期、不可切除的胰腺癌患者，这些患者根据肿瘤与胃和十二指肠的关系，采用基于基准的机器人放射外科系统中的呼吸运动跟踪，接受 3 次 8、10 或 12 Gy（总剂量 24-36 Gy）的 SBRT 治疗。然后为这些患者提供吉西他滨治疗 6 个月或直至耐受或疾病进展。
总的中位随访时间为 24 个月（范围 12-33），局部控制率为 78%，中位总生存时间为 14.3 个月，中位基于碳水化合物抗原 19-9 的无进展生存时间为 7.9 个月，中位计算机断层扫描（CT）确定的无进展生存时间为 9.6 个月。在 36 例患者中，有 28 例（78%）最终发生远处转移。根据正常化肿瘤标志物和稳定的 CT 发现，在最后一次随访（范围 13-30 个月）时，有 6 例（17%）患者无进展。9 例（25%）发生 2 级毒性，5 例（14%）发生 3 级毒性，与 SBRT 相关。
在非转移性、局部晚期、不可切除的胰腺癌患者中，快速有效地进行低分割 SBRT 治疗，副作用可接受，对吉西他滨化疗的干扰最小。
