Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA.
Int J Radiat Oncol Biol Phys. 2012 Jul 15;83(4):1126-31. doi: 10.1016/j.ijrobp.2011.09.041. Epub 2012 Jan 21.
Pancreatic neuroendocrine tumors (NET) are rare and have better disease-related outcomes compared with pancreatic adenocarcinoma. Surgical resection remains the standard of care, although many patients present with locally advanced or metastatic disease. Little is known regarding the use of radiotherapy in the prevention of local recurrence after resection. To better define the role of radiotherapy, we performed an analysis of resected patients at our institution.
Between 1994 and 2009, 33 patients with NET of the pancreatic head and neck underwent treatment with curative intent at Duke University Medical Center. Sixteen patients were treated with surgical resection alone while an additional 17 underwent resection with adjuvant or neoadjuvant radiation therapy, usually with concurrent fluoropyrimidine-based chemotherapy (CMT). Median radiation dose was 50.4 Gy and median follow-up 28 months.
Thirteen patients (39%) experienced treatment failure. Eleven of the initial failures were distant, one was local only and one was local and distant. Two-year overall survival was 77% for all patients. Two-year local control for all patients was 87%: 85% for the CMT group and 90% for the surgery alone group (p = 0.38). Two-year distant metastasis-free survival was 56% for all patients: 46% and 69% for the CMT and surgery patients, respectively (p = 0.10).
The primary mode of failure is distant which often results in mortality, with local failure occurring much less commonly. The role of radiotherapy in the adjuvant management of NET remains unclear.
与胰腺腺癌相比，胰腺神经内分泌肿瘤（NET）较为罕见，且与疾病相关的预后更好。尽管许多患者存在局部晚期或转移性疾病，但手术切除仍然是标准的治疗方法。对于手术后局部复发的预防，放疗的应用知之甚少。为了更好地确定放疗的作用，我们对本机构的切除患者进行了分析。
1994 年至 2009 年间，杜克大学医学中心共有 33 例胰腺头颈部 NET 患者接受了根治性治疗。16 例患者仅接受手术切除，而另外 17 例患者接受了手术切除加辅助或新辅助放疗，通常联合氟嘧啶类化疗（CMT）。中位放疗剂量为 50.4Gy，中位随访时间为 28 个月。
13 例患者（39%）出现治疗失败。最初的失败中有 11 例是远处转移，1 例是局部转移，1 例是局部和远处转移。所有患者的 2 年总生存率为 77%。所有患者的 2 年局部控制率为 87%：CMT 组为 85%，单纯手术组为 90%（p=0.38）。所有患者的 2 年无远处转移生存率为 56%：CMT 组为 46%，手术组为 69%（p=0.10）。
主要的失败模式是远处转移，这通常导致死亡，而局部失败则较少见。放疗在 NET 的辅助治疗中的作用尚不清楚。
