Ma Ningyi, Wang Zheng, Zhao Jiandong, Long Jiang, Xu Jin, Ren Zhigang, Jiang Guoliang
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China (mainland).
Department of Pancreatic and Hepatobiliary Surgery, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China (mainland).
Med Sci Monit. 2017 May 17;23:2315-2323. doi: 10.12659/msm.904393.
BACKGROUND We assessed the role of adjuvant intensity-modulated radiotherapy (IMRT) in combination with chemotherapy for pancreatic carcinomas after curative resection and identified prognostic factors related to pancreatic carcinoma after multidisciplinary treatment strategies. MATERIAL AND METHODS Pancreatic carcinoma patients (n=61) who received adjuvant radiotherapy after resection (median dose, 50.4 Gy) between 2010 and 2016 were retrospectively identified. Sixty patients received chemotherapy, including concurrent chemoradiotherapy (CCRT), systemic chemotherapy, and regional intra-arterial infusion chemotherapy (RIAC). The Kaplan-Meier method was used to measure the 3-year overall survival (OS) and disease-free survival (DFS) rates. Log-rank univariate analysis and multivariate Cox regression model analysis were used to identify prognostic factors. RESULTS Median follow-up time was 25.5 (range, 4.9-59.7) months. The 3-year OS and DFS rates were 31.0% and 16.1%, respectively. The median OS and DFS were 27.4 and 16.7 months, respectively. Multivariate analysis indicated that independent favorable predictors for OS were CCRT (p=0.039) and postoperative RIAC (p=0.044). Moreover, postoperative RIAC (p=0.027), and pre-radiotherapy CA19-9 ≤37 U/mL (p=0.0080) were independent favorable predictors for DFS. The combination of radiotherapy and chemotherapy was tolerated well by the patients, and no treatment-related death occurred. CONCLUSIONS Combined IMRT and adjuvant chemotherapy appeared safe and effective for pancreatic carcinoma. CCRT was associated with improved survival with acceptable toxicity. We propose that radiotherapy could be a part of postoperative treatment, but it should be administered concurrently with chemotherapy. Adding RIAC was associated with improved OS and DFS and it could be integrated into the postoperative treatment regimen.
我们评估了辅助调强放疗（IMRT）联合化疗在胰腺癌根治性切除术后的作用，并确定了多学科治疗策略后与胰腺癌相关的预后因素。
回顾性纳入2010年至2016年间接受切除术后辅助放疗（中位剂量，50.4 Gy）的胰腺癌患者（n = 61）。60例患者接受了化疗，包括同步放化疗（CCRT）、全身化疗和区域动脉内灌注化疗（RIAC）。采用Kaplan-Meier法测量3年总生存率（OS）和无病生存率（DFS）。采用对数秩单因素分析和多因素Cox回归模型分析来确定预后因素。
中位随访时间为25.5（范围，4.9 - 59.7）个月。3年OS率和DFS率分别为31.0%和16.1%。中位OS和DFS分别为27.4个月和16.7个月。多因素分析表明，OS的独立有利预测因素是CCRT（p = 0.039）和术后RIAC（p = 0.044）。此外，术后RIAC（p = 0.027）和放疗前CA19-9≤37 U/mL（p = 0.0080）是DFS的独立有利预测因素。患者对放疗和化疗的联合耐受性良好，未发生与治疗相关的死亡。
IMRT联合辅助化疗对胰腺癌似乎是安全有效的。CCRT与生存改善相关且毒性可接受。我们建议放疗可作为术后治疗的一部分，但应与化疗同时进行。添加RIAC与OS和DFS的改善相关，并且可以纳入术后治疗方案。
