Boimel Pamela J, Berman Abigail T, Li Jonathan, Apisarnthanarax Smith, Both Stefan, Lelionis Kristi, Larson Gary L, Teitelbaum Ursina, Lukens John N, Ben-Josef Edgar, Metz James M, Plastaras John P
Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA.
Department of Radiation Oncology, University of Washington, Seattle, USA.
J Gastrointest Oncol. 2017 Aug;8(4):665-674. doi: 10.21037/jgo.2017.03.04.
Local recurrence following definitive treatment for pancreatic adenocarcinoma is common and can be associated with significant morbidity and mortality. Retreatment options for these patients are limited. Proton beam reirradiation (PRT) may limit dose and toxicity to previously irradiated normal tissues in patients without evidence of metastatic disease.
Between 8/2010-2/2015, 15 patients with isolated, locally-recurrent pancreatic cancer were treated with PRT. Acute toxicity was graded using CTC v 4.0 and defined as occurring within 90 days. Kaplan-Meier survival analysis was performed from the start of PRT. A log-rank test was used to compare survival with or without concurrent chemotherapy.
Median follow-up was 15.7 months [2-48] from the start of PRT. The median clinical target volume (CTV) was 71 cc [15-200]. Ten (67%) patients received concurrent chemotherapy. Median PRT dose was 59.4 Gy (37.5-59.4 Gy). The median time interval from the prior treatment course was 26.7 months (7-461.3). There was a rate of 13% acute ≥ grade 3 toxicities attributed to PRT. The median overall survival (OS) was 16.7 months (95% CI, 4.7-36) and OS at 1 year was 67%. The "in-field" failure free survival at one year was 87%. The locoregional progression free survival (LPFS) and distant metastasis free survival (DMFS) at 1 year was 72% and 64% respectively. Concurrent chemotherapy was associated with a higher median survival.
PRT was well tolerated, resulted in prolonged clinical outcomes compared to historical controls, and should be considered as a treatment option with concurrent chemotherapy in selected patients with locally-recurrent pancreatic cancer.
胰腺癌根治性治疗后局部复发很常见，且可能伴有严重的发病率和死亡率。这些患者的再治疗选择有限。质子束再照射（PRT）可能会限制对无转移疾病证据患者先前照射过的正常组织的剂量和毒性。
在2010年8月至2015年2月期间，15例孤立性局部复发性胰腺癌患者接受了PRT治疗。使用CTC v 4.0对急性毒性进行分级，并定义为在90天内发生。从PRT开始进行Kaplan-Meier生存分析。使用对数秩检验比较接受或未接受同步化疗的患者的生存率。
从PRT开始的中位随访时间为15.7个月[2 - 48个月]。中位临床靶体积（CTV）为71立方厘米[15 - 200立方厘米]。10例（67%）患者接受了同步化疗。PRT的中位剂量为59.4 Gy（37.5 - 59.4 Gy）。自先前治疗疗程起的中位时间间隔为26.7个月（7 - 461.3个月）。PRT导致的急性≥3级毒性发生率为13%。中位总生存期（OS）为16.7个月（95%置信区间，4.7 - 36个月），1年时的OS为67%。1年时的“野内”无失败生存率为87%。1年时的局部区域无进展生存率（LPFS）和远处转移无进展生存率（DMFS）分别为72%和64%。同步化疗与较高的中位生存期相关。
PRT耐受性良好，与历史对照相比可延长临床结局，对于选定的局部复发性胰腺癌患者，应考虑将其作为同步化疗的一种治疗选择。
