University of Florida Proton Therapy Institute, Jacksonville, Florida 32206, USA.
Acta Oncol. 2013 Apr;52(3):498-505. doi: 10.3109/0284186X.2012.762997.
To review treatment toxicity for patients with pancreatic and ampullary cancer treated with proton therapy at our institution.
From March 2009 through April 2012, 22 patients were treated with proton therapy and concomitant capecitabine (1000 mg PO twice daily) for resected (n = 5); marginally resectable (n = 5); and unresectable/inoperable (n = 12) biopsy-proven pancreatic and ampullary adenocarcinoma. Two patients with unresectable disease were excluded from the analysis for reasons unrelated to treatment. Proton doses ranged from 50.40 cobalt gray equivalent (CGE) to 59.40 CGE.
Median follow-up for all patients was 11 (range 5-36) months. No patient demonstrated any grade 3 toxicity during treatment or during the follow-up period. Grade 2 gastrointestinal toxicities occurred in three patients, consisting of vomiting (n = 3); and diarrhea (n = 2). Median weight loss during treatment was 1.3 kg (1.75% of body weight). Chemotherapy was well-tolerated with a median 99% of the prescribed doses delivered. Percentage weight loss was reduced (p = 0.0390) and grade 2 gastrointestinal toxicity was eliminated (p = 0.0009) in patients treated with plans that avoided anterior and left lateral fields which were associated with reduced small bowel and gastric exposure.
Proton therapy may allow for significant sparing of the small bowel and stomach and is associated with a low rate of gastrointestinal toxicity. Although long-term follow-up will be needed to assess efficacy, we believe that the favorable toxicity profile associated with proton therapy may allow for radiotherapy dose escalation, chemotherapy intensification, and possibly increased acceptance of preoperative radiotherapy for patients with resectable or marginally resectable disease.
回顾本机构接受质子治疗的胰腺和壶腹腺癌患者的治疗毒性。
从 2009 年 3 月至 2012 年 4 月，22 例患者接受质子治疗和同期卡培他滨（1000mg PO 每日两次）治疗，包括已切除（n=5）；边缘可切除（n=5）；以及不可切除/不可手术（n=12）活检证实的胰腺和壶腹腺癌。由于与治疗无关的原因，2 例不可切除疾病患者被排除在分析之外。质子剂量范围为 50.40 钴灰等效物（CGE）至 59.40 CGE。
所有患者的中位随访时间为 11（范围 5-36）个月。治疗期间或随访期间无患者出现任何 3 级毒性。3 例患者出现 2 级胃肠道毒性，包括呕吐（n=3）；腹泻（n=2）。治疗期间体重中位数下降 1.3kg（体重的 1.75%）。化疗耐受良好，中位数 99%的规定剂量给药。避免了与小肠和胃暴露减少相关的前侧和左侧野的计划治疗患者体重减轻百分比降低（p=0.0390）和 2 级胃肠道毒性消除（p=0.0009）。
质子治疗可能会显著减少小肠和胃的照射，并且与胃肠道毒性发生率低相关。尽管需要长期随访来评估疗效，但我们认为质子治疗相关的良好毒性特征可能允许放疗剂量升级、化疗强化，并且可能增加对可切除或边缘可切除疾病患者的术前放疗的接受度。
