Department of Radiation Oncology, University of Pittsburgh Cancer Institute, 5150 Centre Avenue, #545, Pittsburgh, PA 15232, USA.
Radiat Oncol. 2013 Oct 16;8:240. doi: 10.1186/1748-717X-8-240.
Treatment of pancreatic adenocarcinoma in the elderly is often complicated by comorbidities that preclude surgery, chemotherapy and/or conventional external beam radiation therapy (EBRT). Stereotactic body radiotherapy (SBRT) has thus garnered interest in this setting.
A retrospective review of 26 patients of age ≥ 80 with pancreatic adenocarcinoma treated with definitive SBRT+/-chemotherapy from 2007-2011 was performed. Twenty-seven percent of patients were stage I, 38% were stage II, 27% were stage III and 8% were stage IV. Patients most commonly received 24 Gy/1 fraction or 30-36 Gy/3 fractions. Kaplan-Meier was used to estimate overall survival (OS), local control (LC), cause specific survival (CSS) and freedom-from-metastatic disease (FFMD).
The median age was 86 (range 80-91), and median follow-up was 11.6 months (3.5-24.6). The median planning target volume was 21.48 cm3 (6.1-85.09). Median OS was 7.6 months with 6/12 month OS rates of 65.4%/34.6%, respectively. Median LC was 11.5 months, 6-month and 12-month actuarial LC rates were 60.1% and 41.2%, respectively. There were no independent predictors for LC, but there was a trend for improved LC with prescription dose greater than 20 Gy (p = 0.063). Median CSS was 6.3 months, and 6-month and 12-month actuarial CSS were 53.8% and 23.1%, respectively. Median FFMD was 8.4 months, and 6-month and 12-month actuarial rates were 62.0% and 41.4%, respectively. Nine patients (47%) had local failures, 11 (58%) had distant metastasis, and 7 (37%) had both. There were no acute or late grade 3+ toxicities.
Definitive SBRT is feasible, safe and effective in elderly patients who have unresectable disease, have comorbidities precluding surgery or decline surgery.
老年人胰腺癌的治疗常因合并症而变得复杂，这些合并症使手术、化疗和/或常规外照射放疗（EBRT）无法进行。立体定向体放射治疗（SBRT）因此在这种情况下引起了关注。
对 2007 年至 2011 年间接受根治性 SBRT+/-化疗的 26 名年龄≥80 岁的胰腺腺癌患者进行回顾性分析。27%的患者为 I 期，38%为 II 期，27%为 III 期，8%为 IV 期。患者最常接受 24 Gy/1 次或 30-36 Gy/3 次。采用 Kaplan-Meier 法估计总生存率（OS）、局部控制率（LC）、无病生存率（FFMD）和无远处转移生存率（CSS）。
中位年龄为 86 岁（范围为 80-91 岁），中位随访时间为 11.6 个月（3.5-24.6 个月）。中位计划靶区体积为 21.48 cm3（6.1-85.09 cm3）。中位 OS 为 7.6 个月，6/12 个月 OS 率分别为 65.4%和 34.6%。中位 LC 为 11.5 个月，6 个月和 12 个月的实际 LC 率分别为 60.1%和 41.2%。LC 无独立预测因素，但随着处方剂量大于 20 Gy，LC 有改善的趋势（p=0.063）。中位 CSS 为 6.3 个月，6 个月和 12 个月的实际 CSS 率分别为 53.8%和 23.1%。中位 FFMD 为 8.4 个月，6 个月和 12 个月的实际 FFMD 率分别为 62.0%和 41.4%。9 例（47%）患者出现局部失败，11 例（58%）患者出现远处转移，7 例（37%）患者同时出现局部和远处转移。无急性或迟发性 3+级毒性。
在不能手术、手术合并症或拒绝手术的老年患者中，根治性 SBRT 是可行、安全和有效的。
