Shibamoto Y, Manabe T, Baba N, Sasai K, Takahashi M, Tobe T, Abe M
Department of Radiology, Faculty of Medicine, Kyoto University, Japan.
Int J Radiat Oncol Biol Phys. 1990 Sep;19(3):605-11. doi: 10.1016/0360-3016(90)90486-4.
Ninety patients with pancreatic cancer were treated by external beam radiotherapy (EBRT) and/or intraoperative radiotherapy (IORT) with or without surgical resection of the tumor, and the results were compared with those of a historical control comprising 112 patients treated by surgery alone. At an early stage of this study, postoperative EBRT (50-60 Gy) or IORT (25-33 Gy) was given alone, but recently the two modalities have been combined. The combination of high doses of EBRT and IORT was well tolerated provided that the gastrointestinal tract was not irradiated during IORT. Although EBRT plus IORT appeared to yield better results than either EBRT or IORT alone, the difference was not significant on multivariate analysis, and patients receiving EBRT, IORT, or EBRT + IORT were grouped together. Patients receiving radiotherapy in addition to macroscopically curative surgery had a slightly longer median survival time (14 months) than those receiving curative surgery alone (10 months), but the 3-year survival rate was similar (21% vs. 19%). In patients who underwent noncurative resection, the median survival time was significantly longer for the irradiated group (12 months) than for the control group (6.5 months). Also, in patients with unresectable lesions but no distant metastases, irradiation prolonged the median survival time significantly (8 vs. 3.5 months). In this group, there was one 5-year survivor, who received EBRT of 55 Gy plus IORT of 30 Gy to his unresectable pancreatic body lesion. Patients with metastases were also treated for palliation of symptoms, but it was found that irradiation prolonged the median survival time even in such cases (4.5 vs. 2.5 months). Based on these results, we plan to use EBRT plus IORT in all pancreatic cancer patients with no metastases.
90例胰腺癌患者接受了体外照射放疗（EBRT）和/或术中放疗（IORT），部分患者接受了肿瘤切除术，部分未接受，研究将这些患者的治疗结果与112例仅接受手术治疗的历史对照患者的结果进行了比较。在本研究的早期阶段，单独给予术后EBRT（50 - 60 Gy）或IORT（25 - 33 Gy），但最近这两种方式已联合使用。只要在IORT期间不照射胃肠道，高剂量EBRT和IORT联合使用耐受性良好。虽然EBRT加IORT似乎比单独使用EBRT或IORT产生更好的结果，但多因素分析显示差异不显著，接受EBRT、IORT或EBRT + IORT的患者被归为一组。除了接受肉眼可见的根治性手术外还接受放疗的患者，其中位生存时间（14个月）略长于仅接受根治性手术的患者（10个月），但3年生存率相似（21%对19%）。在接受非根治性切除的患者中，照射组的中位生存时间（12个月）明显长于对照组（6.5个月）。此外，在有不可切除病变但无远处转移的患者中，照射显著延长了中位生存时间（8个月对3.5个月）。在该组中，有1例5年生存者，其不可切除的胰体病变接受了55 Gy的EBRT加30 Gy的IORT。有转移的患者也接受了姑息性治疗，结果发现即使在这种情况下照射也延长了中位生存时间（4.5个月对2.5个月）。基于这些结果，我们计划在所有无转移的胰腺癌患者中使用EBRT加IORT。
