Department of Radiology, University of the Ryukyus, Okinawa, Japan.
Int J Radiat Oncol Biol Phys. 2012 Jun 1;83(2):559-65. doi: 10.1016/j.ijrobp.2011.07.013. Epub 2011 Oct 20.
To retrospectively analyze results of concurrent chemoradiotherapy (CCRT) using gemcitabine (GEM) for unresectable pancreatic adenocarcinoma.
Records of 108 patients treated with concurrent external beam radiotherapy (EBRT) and GEM were reviewed. The median dose of EBRT in all 108 patients was 50.4 Gy (range, 3.6-60.8 Gy), usually administered in conventional fractionations (1.8-2 Gy/day). During radiotherapy, most patients received GEM at a dosage of 250 to 350 mg/m(2) intravenously weekly for approximately 6 weeks. After CCRT, 59 patients (54.6%) were treated with adjuvant chemotherapy (AC), mainly with GEM. The median follow-up for all 108 patients was 11.0 months (range, 0.4-37.9 months).
Initial responses after CCRT for 85 patients were partial response: 26 patients, no change: 51 patients and progressive disease: 8 patients. Local progression was observed in 35 patients (32.4%), and the 2-year local control (LC) rate in all patients was 41.9%. Patients treated with total doses of 50 Gy or more had significantly more favorable LC rates (2-year LC rate, 42.9%) than patients treated with total doses of less than 50 Gy (2-year LC rate, 29.6%). Regional lymph node recurrence was found in only 1 patient, and none of the 57 patients with clinical N0 disease had regional lymph node recurrence. The 2-year overall survival (OS) rate and the median survival time in all patients were 23.5% and 11.6 months, respectively. Patients treated with AC had significantly more favorable OS rates (2-year OS, 31.8%) than those treated without AC (2-year OS, 12.4%; p < 0.0001). On multivariate analysis, AC use and clinical T stage were significant prognostic factors for OS.
CCRT using GEM yields a relatively favorable LC rate for unresectable pancreatic adenocarcinoma, and CCRT with AC conferred a survival benefit compared to CCRT without AC.
回顾性分析吉西他滨（GEM）联合放化疗治疗不可切除胰腺腺癌的结果。
对 108 例接受同期外照射放疗（EBRT）和 GEM 治疗的患者的记录进行了回顾性分析。所有 108 例患者的 EBRT 中位剂量为 50.4Gy（范围为 3.6-60.8Gy），通常采用常规分割（1.8-2Gy/天）。放疗期间，大多数患者每周静脉给予 GEM 250-350mg/m²，约 6 周。CCRT 后，59 例（54.6%）患者接受辅助化疗（AC），主要使用 GEM。所有 108 例患者的中位随访时间为 11.0 个月（范围为 0.4-37.9 个月）。
85 例患者 CCRT 后的初始反应为部分缓解：26 例，无变化：51 例，进展：8 例。35 例（32.4%）患者出现局部进展，所有患者的 2 年局部控制（LC）率为 41.9%。总剂量为 50Gy 或更高的患者 LC 率显著更高（2 年 LC 率为 42.9%），而总剂量低于 50Gy 的患者 LC 率为 29.6%。仅 1 例患者发现区域淋巴结复发，57 例临床 N0 疾病患者均无区域淋巴结复发。所有患者的 2 年总生存率（OS）率和中位生存时间分别为 23.5%和 11.6 个月。接受 AC 治疗的患者 OS 率显著更高（2 年 OS 率为 31.8%），而未接受 AC 治疗的患者 OS 率为 12.4%（p<0.0001）。多因素分析显示，AC 应用和临床 T 分期是 OS 的显著预后因素。
GEM 联合放化疗治疗不可切除胰腺腺癌可获得相对较好的 LC 率，与单纯放化疗相比，联合 AC 治疗可带来生存获益。
