Harvard Medical School, Boston, Massachusetts.
Cancer. 2013 Dec 1;119(23):4196-204. doi: 10.1002/cncr.28329. Epub 2013 Sep 4.
In the current study, the authors evaluated long-term outcomes, intraoperative radiotherapy (IORT)-related toxicity, and prognostic factors for overall survival (OS) among patients with unresectable locally advanced pancreatic cancer (LAPC) who received IORT as part of their treatment at the Massachusetts General Hospital (MGH).
Medical records were reviewed for 194 consecutive patients with unresectable LAPC who were treated with IORT at MGH between 1978 and 2010. OS was calculated using the Kaplan-Meier method. Prognostic factors were evaluated at the univariate level by the log-rank test and at the multivariate level by the Cox proportional hazards model. Rates of disease progression and treatment toxicity were calculated.
The 1-year, 2-year, and 3-year survival rates were 49%, 16%, and 6%, respectively. Six patients (3%) survived for > 5 years. The median OS was 12.0 months. Among 183 patients with known post-IORT disease status, the 2-year local progression-free survival and distant metastasis-free survival rates were 41% and 28%, respectively. On multivariate analysis, an IORT applicator diameter ≤ 8 cm (hazards ratio [HR], 0.51; 95% confidence interval [95% CI], 0.30-0.84 [P = .009]), a Charlson age-comorbidity index ≤ 3 (HR, 0.47; 95% CI, 0.31-0.73 [P = .001]), and receipt of chemotherapy (HR, 0.46; 95% CI, 0.33-0.66 [P < .001]) predicted improved OS. The median OS for patients with all 3 positive prognostic factors was 21.2 months.
Well-selected patients with LAPC with small tumors and low Charlson age-comorbidity indices can achieve good long-term survival outcomes with a treatment regimen that incorporates chemotherapy and IORT.
在本研究中，作者评估了在马萨诸塞州综合医院（MGH）接受术中放疗（IORT）治疗的无法切除的局部晚期胰腺癌（LAPC）患者的长期结果、IORT 相关毒性以及总生存（OS）的预后因素。
回顾性分析了 194 例 1978 年至 2010 年期间在 MGH 接受 IORT 治疗的无法切除的 LAPC 患者的病历。采用 Kaplan-Meier 法计算 OS。采用对数秩检验在单因素水平和 Cox 比例风险模型在多因素水平评估预后因素。计算疾病进展和治疗毒性的发生率。
1 年、2 年和 3 年生存率分别为 49%、16%和 6%。6 例（3%）患者存活时间超过 5 年。中位 OS 为 12.0 个月。在 183 例已知 IORT 后疾病状态的患者中，2 年局部无进展生存率和远处转移无进展生存率分别为 41%和 28%。多因素分析显示，IORT 施源器直径≤8cm（风险比[HR]，0.51；95%置信区间[95%CI]，0.30-0.84[P=0.009]）、Charlson 年龄合并症指数≤3（HR，0.47；95%CI，0.31-0.73[P=0.001]）和接受化疗（HR，0.46；95%CI，0.33-0.66[P<0.001]）预测 OS 改善。所有 3 个阳性预后因素的患者中位 OS 为 21.2 个月。
选择合适的小肿瘤和低 Charlson 年龄合并症指数的 LAPC 患者，采用化疗和 IORT 联合治疗方案可获得良好的长期生存结果。
