Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea.
Int J Radiat Oncol Biol Phys. 2012 Aug 1;83(5):1448-54. doi: 10.1016/j.ijrobp.2011.10.050. Epub 2012 Jan 27.
To improve poor therapeutic outcome of current practice of chemoradiotherapy (CRT), high-dose helical tomotherapy (HT) with concurrent full-dose chemotherapy has been performed on patients with locally advanced pancreatic cancer (LAPC), and the results were analyzed.
We retrospectively reviewed 39 patients with LAPC treated with radiotherapy using HT (median, 58.4 Gy; range, 50.8-59.9 Gy) and concomitant chemotherapy between 2006 and 2009. Radiotherapy was directed to the primary tumor with a 0.5-cm margin without prophylactic nodal coverage. Twenty-nine patients (79%) received full-dose (1000 mg/m(2)) gemcitabine-based chemotherapy during HT. After completion of CRT, maintenance chemotherapy was administered to 37 patients (95%).
The median follow-up was 15.5 months (range, 3.4-43.9) for the entire cohort, and 22.5 months (range, 12.0-43.9) for the surviving patients. The 1- and 2-year local progression-free survival rates were 82.1% and 77.3%, respectively. Eight patients (21%) were converted to resectable status, including 1 with a pathological complete response. The median overall survival and progression-free survival were 21.2 and 14.0 months, respectively. Acute toxicities were acceptable with no gastrointestinal (GI) toxicity higher than Grade 3. Severe late GI toxicity (≥ Grade 3) occurred in 10 patients (26%); 1 treatment-related death from GI bleeding was observed.
High-dose helical tomotherapy with concurrent full-dose chemotherapy resulted in improved local control and long-term survival in patients with LAPC. Future studies are needed to widen the therapeutic window by minimizing late GI toxicity.
为了改善目前放化疗（CRT）的不良治疗效果，对局部晚期胰腺癌（LAPC）患者进行了高剂量螺旋断层放疗（HT）联合全剂量化疗，现对结果进行分析。
我们回顾性分析了 2006 年至 2009 年间 39 例接受 HT 放疗（中位剂量 58.4Gy；范围 50.8-59.9Gy）和同期化疗的 LAPC 患者。放疗靶区包括原发肿瘤，边缘外放 0.5cm，不预防性照射淋巴结。29 例（79%）患者在 HT 期间接受全剂量（1000mg/m²）吉西他滨为基础的化疗。CRT 完成后，37 例（95%）患者接受维持化疗。
全队列的中位随访时间为 15.5 个月（范围 3.4-43.9），存活患者的中位随访时间为 22.5 个月（范围 12.0-43.9）。1 年和 2 年局部无进展生存率分别为 82.1%和 77.3%。8 例（21%）患者转化为可切除状态，其中 1 例达到病理完全缓解。中位总生存期和无进展生存期分别为 21.2 个月和 14.0 个月。急性毒性可耐受，无胃肠道（GI）毒性高于 3 级。10 例（26%）患者发生严重迟发性 GI 毒性（≥3 级），1 例因 GI 出血死亡。
高剂量螺旋断层放疗联合全剂量化疗可提高局部晚期胰腺癌患者的局部控制率和长期生存率。未来需要进一步研究以降低迟发性 GI 毒性，从而扩大治疗窗口。
