Radiation Oncology of the Friedrich-Alexander University of Erlangen-Nuremberg, Universitätsstraße 22, 91054 Erlangen, Germany.
Radiat Oncol. 2011 Jul 27;6:88. doi: 10.1186/1748-717X-6-88.
Despite of a growing number of gemcitabine based chemoradiotherapy studies in locally advanced pancreatic cancer (LAPC), 5-fluorouracil based regimens are still regarded to be standard and the debate of superiority between the two drugs is going on. The aim of this retrospective analysis was to evaluate the effect of two concurrent chemoradiotherapy regimens using 5-fluorouracil or gemcitabine to compare their effect and tolerance.
We have performed a single centre retrospective analysis of 93 patients treated with conventionally fractionated radiotherapy of 55.8 Gray using either concurrent 5-fluorouracil, 1 g/m² on days 1-5 and 29-33 of radiotherapy and 10 mg/m² of mitomycin C on day 1, 29 of radiotherapy (FM group, 35 patients) versus gemcitabine (300 mg/m²) and cisplatin, (30 mg/m²) on days 1, 8, 22, and 29 (GC group, 58 patients). Primary endpoint was the median overall survival (OS) rate.
The median OS rate was 12.7 months in the GC group and 9.7 months in the FM group. The 1-year OS rate was 53% versus 40%, respectively (p = 0.009). GC led to more grade 3 leukocytopenia and thrombocytopenia than FM, but not to more grade 4 myelosuppression. Thrombocytopenia was the most frequently observed grade 4 toxicity in both groups (11% after FM versus 12% after GC). No grade 3/4 febrile neutropenia was observed. Grade 3 nausea was more common in the FM group (20% versus 9%) and grade 4 nausea was observed in one patient per group only.
GC was superior to FM for overall survival and both regimens were similar in terms of tolerance. We conclude that GC leads to encouraging results and that the use of FM for chemoradiotherapy in LAPC cannot be recommended without concerns.
尽管局部晚期胰腺癌（LAPC）的吉西他滨为基础的放化疗研究越来越多，但氟尿嘧啶为基础的方案仍被认为是标准方案，两种药物之间的优劣之争仍在继续。本回顾性分析的目的是评估使用氟尿嘧啶或吉西他滨的两种同期放化疗方案的效果，比较它们的效果和耐受性。
我们对 93 例接受常规分割放疗（55.8Gy）的患者进行了单中心回顾性分析，这些患者分别接受了同期氟尿嘧啶（1g/m²，放疗第 1-5 天和第 29-33 天）和丝裂霉素 C（10mg/m²，放疗第 1 天和第 29 天）（FM 组，35 例）或吉西他滨（300mg/m²）和顺铂（30mg/m²）（GC 组，58 例）治疗。主要终点是中位总生存期（OS）率。
GC 组的中位 OS 率为 12.7 个月，FM 组为 9.7 个月。1 年 OS 率分别为 53%和 40%（p=0.009）。GC 导致的 3 级白细胞减少和血小板减少比 FM 组更为常见，但没有导致 4 级骨髓抑制。血小板减少是两组中最常见的 4 级毒性（FM 组为 11%，GC 组为 12%）。未观察到 3/4 级发热性中性粒细胞减少症。FM 组 3/4 级恶心更为常见（20% vs. 9%），两组均有 1 例患者出现 4 级恶心。
GC 在总生存方面优于 FM，两种方案在耐受性方面相似。我们得出结论，GC 带来了令人鼓舞的结果，因此，在没有顾虑的情况下，不能推荐 FM 用于 LAPC 的放化疗。
