不可切除的晚期胰腺癌的立体定向体部放疗：单中心经验的初步结果
SBRT in unresectable advanced pancreatic cancer: preliminary results of a mono-institutional experience.
作者信息
Tozzi Angelo, Comito Tiziana, Alongi Filippo, Navarria Pierina, Iftode Cristina, Mancosu Pietro, Reggiori Giacomo, Clerici Elena, Rimassa Lorenza, Zerbi Alessandro, Fogliata Antonella, Cozzi Luca, Tomatis Stefano, Scorsetti Marta
出版信息
Radiat Oncol. 2013 Jun 21;8:148. doi: 10.1186/1748-717X-8-148.
BACKGROUND
To assess the efficacy and safety of stereotactic body radiotherapy (SBRT) in patients with either unresectable locally advanced pancreatic adenocarcinoma or by locally recurrent disease after surgery.
METHODS
Between January 2010 and October 2011, 30 patients with unresectable or recurrent pancreatic adenocarcinoma underwent exclusive SBRT. Twenty-one patients (70%) presented with unresectable locally advanced disease and 9 patients (30%) showed local recurrence after surgery. No patients had metastatic disease. Gemcitabine-based chemotherapy was administered to all patients before SBRT. Prescription dose was 45Gy in 6 daily fractions of 7.5Gy. SBRT was delivered using the volumetric modulated arc therapy (VMAT) by RapidArc. Primary end-point of this study was freedom from local progression (FFLP), secondary end-points were overall survival (OS), progression free survival (PFS) and toxicity.
RESULTS
Median Clinical Target Volume (CTV) was 25.6 cm3 (3.2-78.8 cm3) and median Planning Target Volume (PTV) was 70.9 cm3 (20.4- 205.2 cm3). The prescription dose was delivered in 25 patients (83%), in 5 patients (17%) it was reduced to 36Gy in 6 fractions not to exceed the dose constraints of organs at risk (OARs). Median follow-up was 11 months (2-28 months). FFLP was 91% at 6 months, 85% at median follow-up and 77% at 1 and 2 years. For the group with prescription dose of 45Gy, FFLP was 96% at 1 and 2 years. The median PFS was 8 months. The OS was 47% at 1 year and median OS was 11 months. At the end of the follow-up, 9 patients (32%) were alive and 4 (14%) were free from progression. No patients experienced G ≥ 3 acute toxicity.
CONCLUSIONS
Our preliminary results show that SBRT can obtain a satisfactory local control rate for unresectable locally advanced and recurrent pancreatic adenocarcinoma. This fractionation schedule is feasible, and no G ≥ 3 toxicity was observed. SBRT is an effective emerging technique in the multi-modality treatment of locally advanced pancreatic tumors.
背景
评估立体定向体部放疗（SBRT）治疗无法切除的局部晚期胰腺腺癌患者或术后局部复发患者的疗效和安全性。
方法
2010年1月至2011年10月期间，30例无法切除或复发的胰腺腺癌患者接受了单纯SBRT治疗。21例（70%）患者表现为无法切除的局部晚期疾病，9例（30%）患者术后出现局部复发。所有患者均无转移性疾病。所有患者在SBRT治疗前均接受了以吉西他滨为基础的化疗。处方剂量为45Gy，分6次，每次7.5Gy。使用容积调强弧形放疗（VMAT）技术的RapidArc进行SBRT治疗。本研究的主要终点是无局部进展生存期（FFLP），次要终点是总生存期（OS）、无进展生存期（PFS）和毒性反应。
结果
临床靶区（CTV）中位体积为25.6 cm³（3.2 - 78.8 cm³），计划靶区（PTV）中位体积为70.9 cm³（20.4 - 205.2 cm³）。25例（83%）患者接受了处方剂量的放疗，5例（17%）患者剂量减至36Gy，分6次，以不超过危及器官（OAR）的剂量限制。中位随访时间为11个月（2 - 28个月）。6个月时FFLP为91%，中位随访时为85%，1年和2年时为77%。对于处方剂量为45Gy的组，1年和2年时FFLP为96%。中位PFS为8个月。1年时OS为47%，中位OS为11个月。随访结束时，9例（32%）患者存活，4例（14%）患者无疾病进展。无患者发生G≥3级急性毒性反应。
结论
我们的初步结果表明，SBRT对于无法切除的局部晚期和复发胰腺腺癌可获得满意的局部控制率。这种分割方案是可行的，且未观察到G≥3级毒性反应。SBRT是局部晚期胰腺肿瘤多模式治疗中一种有效的新兴技术。
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