Hirata Takero, Teshima Teruki, Nishiyama Kinji, Ogawa Kazuhiko, Otani Keisuke, Kawaguchi Yoshifumi, Konishi Koji, Tomita Yasuhiko, Takahashi Hidenori, Ohigashi Hiroaki, Ishikawa Osamu
Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan; Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Radiother Oncol. 2015 Jan;114(1):122-7. doi: 10.1016/j.radonc.2015.01.004. Epub 2015 Jan 19.
Histopathological findings of patients who underwent resection for pancreatic adenocarcinoma (PC) after preoperative chemoradiotherapy (CRT) reportedly showed beneficial effects. The purpose of our study was to evaluate the correlation between histopathological effects (HE) of preoperative CRT and treatment parameters [radiation and gemcitabine (GEM) doses].
HE of CRT were assessed on 158 primary lesions of 157 patients with PC who underwent pancreatic resection after preoperative CRT with GEM between January 2006 and December 2011. The radiation dose delivered to the primary tumor site and surrounding regional nodal areas was 50 Gy until September 2009 followed by the dose escalation of a 10 Gy boost added for delivery with the field-in-field technique to the roots of the celiac and superior mesenteric arteries. Intravenous administration of GEM (1000 /m(2)) was initiated concurrently on days 1, 8, and 15, every 4 weeks and generally repeated for 3 cycles. HE of CRT on the primary tumor were categorized based on the number of tumor cells destroyed.
The median overall survival time was 74.5 months and 3-year and 5-year survival rates were 64.3% and 54.5%, respectively. Dose-volume parameters of radiation such as D33 with a cut-off value of 51.6 Gy were correlated significantly with HE (p=.0230). Lesions having received GEM>7625 mg/m(2) before surgical resection more frequently showed positive HE (p=.0002). Multivariate logistic regression analysis demonstrated that both D33 and cumulative GEM dose were significant predictors of definite HE (p=.0110 and <.0001, respectively).
Our retrospective analysis showed that dose intensity of radiation and GEM is significantly related to HE of preoperative CRT for PC.
据报道，术前放化疗（CRT）后接受胰腺腺癌（PC）切除术患者的组织病理学检查结果显示出有益效果。本研究的目的是评估术前CRT的组织病理学效应（HE）与治疗参数[放疗和吉西他滨（GEM）剂量]之间的相关性。
对2006年1月至2011年12月期间157例接受术前CRT联合GEM治疗后行胰腺切除术的PC患者的158个原发性病变的CRT的HE进行评估。2009年9月之前，原发肿瘤部位及周围区域淋巴结区域的放疗剂量为50 Gy，随后采用野中野技术将剂量增加10 Gy，追加至腹腔干和肠系膜上动脉根部。静脉注射GEM（1000 /m(2)）在第1、8和15天同时开始，每4周一次，一般重复3个周期。根据破坏的肿瘤细胞数量对原发肿瘤的CRT的HE进行分类。
中位总生存时间为74.5个月，3年和5年生存率分别为64.3%和54.5%。放疗剂量体积参数如截止值为51.6 Gy的D33与HE显著相关（p = 0.0230）。手术切除前接受GEM>7625 mg/m(2)的病变更常显示HE阳性（p = 0.0002）。多因素逻辑回归分析表明，D33和累积GEM剂量均是明确HE的显著预测因素（分别为p = 0.0110和<0.0001）。
我们的回顾性分析表明，放疗和GEM的剂量强度与PC术前CRT的HE显著相关。
