Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL 60637, USA.
Radiat Oncol. 2012 Sep 13;7:156. doi: 10.1186/1748-717X-7-156.
Unresectable pancreatic cancer (UPC) has low survival. With improving staging techniques and systemic therapy, local control in patients without metastatic disease may have increasing importance. We investigated whether the radiation dose used in chemoradiation (CRT) as definitive treatment for UPC and the CA 19-9 response to therapy have an impact on overall survival (OS).
From 1997-2009 46 patients were treated with CRT for non-metastatic UPC. Median prescribed RT dose was 54 Gy (range 50.4-59.4 Gy). All patients received concurrent chemotherapy (41: 5-fluorouracil, 5: other) and 24 received adjuvant chemotherapy.
41 patients were inoperable due to T4 disease and 5 patients with T3 disease were medically inoperable. Five patients did not complete CRT due to progressive disease or treatment-related toxicity (median RT dose 43.2 Gy). Overall, 42 patients were dead of disease at the time of last follow-up. The median and 12 month OS were 8.8 months and 35%, respectively. By univariate analysis, minimum CA 19-9 post-CRT <90 U/mL was favorably associated with OS (12.3 versus 8.8 months, p = 0.012). Radiotherapy dose ≥54 Gy trended towards improved OS (11.3 versus 6.8 months, p = 0.089). By multivariable analysis, a delivered RT dose of ≥54 Gy (HR 0.47, p = 0.028) and minimum CA 19-9 post-CRT of <90 U/mL (HR 0.35, p = 0.008) were associated with OS.
CRT as definitive treatment for UPC had low survival. However, our retrospective data suggest that patients treated to ≥54 Gy or observed to have a minimum post-CRT CA 19-9 <90 U/mL had improved likelihood of long-term survival.
无法切除的胰腺癌（UPC）的生存率较低。随着分期技术和系统治疗的提高，对于没有转移疾病的患者，局部控制可能变得越来越重要。我们研究了放化疗（CRT）作为 UPC 确定性治疗时使用的放射剂量以及治疗后 CA 19-9 的反应是否会对总生存期（OS）产生影响。
1997 年至 2009 年间，46 例非转移性 UPC 患者接受 CRT 治疗。中位规定的 RT 剂量为 54 Gy（范围 50.4-59.4 Gy）。所有患者均接受同期化疗（41 例：5-氟尿嘧啶，5 例：其他），24 例接受辅助化疗。
41 例患者因 T4 期疾病而无法手术，5 例 T3 期疾病的患者因医学原因无法手术。由于疾病进展或治疗相关毒性，5 例患者未完成 CRT（中位 RT 剂量 43.2 Gy）。总的来说，42 例患者在最后一次随访时死于疾病。中位和 12 个月 OS 分别为 8.8 个月和 35%。单因素分析显示，最低的 CRT 后 CA 19-9<90 U/mL 与 OS 呈正相关（12.3 个月比 8.8 个月，p=0.012）。放疗剂量≥54 Gy 有改善 OS 的趋势（11.3 个月比 6.8 个月，p=0.089）。多因素分析显示，RT 剂量≥54 Gy（HR 0.47，p=0.028）和 CRT 后最低 CA 19-9<90 U/mL（HR 0.35，p=0.008）与 OS 相关。
作为 UPC 的确定性治疗，CRT 的生存率较低。然而，我们的回顾性数据表明，接受≥54 Gy 剂量治疗或观察到 CRT 后 CA 19-9 最低值<90 U/mL 的患者，长期生存的可能性更高。
