Kang Huapyong, Chang Jee Suk, Oh Tak Geun, Chung Moon Jae, Park Jeong Youp, Park Seung Woo, Seong Jinsil, Song Si Young, Chung Jae Bok, Bang Seungmin
Division of Gastroenterology, Department of Internal Medicine and Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea.
Chemotherapy. 2014;60(3):191-9. doi: 10.1159/000375402. Epub 2015 Mar 25.
To compare the efficacy of full-dose gemcitabine-based concurrent chemoradiotherapy (FG-CCRT) and conventional 5-fluorouracil CCRT (5FU-CCRT) for locally advanced pancreatic cancer (LAPC).
109 LAPC cases treated with FG-CCRT (n = 89) or 5FU-CCRT (n = 20) were reviewed retrospectively. The FG-CCRT group was composed of a full-dose gemcitabine monotherapy (1,000 mg/m(2)) arm and a combination therapy with cisplatin (70 mg/m(2)) arm. The 5FU-CCRT group used a radiosensitizing dose of 5-FU (500 mg/m(2)) plus leucovorin (20 mg/m(2)). Concurrent radiotherapy was targeted at the tumor with a 5-mm margin without lymph node irradiation.
Objective response rate (ORR) and disease control rate (DCR) was significantly higher in the FG-CCRT group (ORR: 32.6 vs. 5%, p = 0.013; DCR: 79.8 vs. 50.0%, p = 0.006). FG-CCRT showed remarkable superiority to 5FU-CCRT for suppressing distant metastasis (18.0 vs. 45.0%, p = 0.017). Neutropenia (34.8 vs. 10%, p = 0.032) and thrombocytopenia (21.3 vs. 0.0%, p = 0.021) were more frequent in the FG-CCRT group as originally expected. When dividing the FG-CCRT group to gemcitabine monotherapy (GEM) and gemcitabine plus cisplatin, toxicities of the GEM subgroup were not different than those of the 5FU-CCRT group.
FG-CCRT, especially full-dose gemcitabine monotherapy-based CCRT was more effective for the initial control of LAPC than 5FU-CCRT, and also relatively safe.
比较全剂量吉西他滨同步放化疗（FG-CCRT）与传统5-氟尿嘧啶同步放化疗（5FU-CCRT）治疗局部晚期胰腺癌（LAPC）的疗效。
回顾性分析109例接受FG-CCRT（n = 89）或5FU-CCRT（n = 20）治疗的LAPC患者。FG-CCRT组包括全剂量吉西他滨单药治疗（1000 mg/m²）组和顺铂（70 mg/m²）联合治疗组。5FU-CCRT组采用5-氟尿嘧啶放射增敏剂量（500 mg/m²）加亚叶酸钙（20 mg/m²）。同步放疗针对肿瘤，外放5 mm边界，不进行淋巴结照射。
FG-CCRT组的客观缓解率（ORR）和疾病控制率（DCR）显著更高（ORR：32.6%对5%，p = 0.013；DCR：79.8%对50.0%，p = 0.006）。FG-CCRT在抑制远处转移方面显示出优于5FU-CCRT的显著优势（18.0%对45.0%，p = 0.017）。正如最初预期的那样，FG-CCRT组中性粒细胞减少（34.8%对10%，p = 0.032）和血小板减少（21.3%对0.0%，p = 0.021）更为常见。将FG-CCRT组分为吉西他滨单药治疗（GEM）组和吉西他滨加顺铂组时，GEM亚组的毒性与5FU-CCRT组无差异。
FG-CCRT，尤其是基于全剂量吉西他滨单药治疗的CCRT，在LAPC的初始控制方面比5FU-CCRT更有效，且相对安全。
