Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin, Kawaracho, Sakyo-ku, Kyoto, Japan.
Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan.
Radiat Oncol. 2018 Jun 25;13(1):118. doi: 10.1186/s13014-018-1063-5.
BACKGROUND: The purpose was to retrospectively evaluate the effect of intensity-modulated radiotherapy (IMRT) on gastrointestinal (GI) toxicities and outcomes compared to three-dimensional conformal radiotherapy (3DCRT) for locally advanced pancreatic cancer (LAPC). METHODS: We included 107 consecutive patients who underwent CRT for LAPC from September 2001 to March 2015; 80 patients underwent 3DCRT and 27 patients underwent IMRT. They were compared for GI toxicities, locoregional progression free survival (LRPFS), distant metastasis free survival (DMS), and overall survival (OS). RESULTS: Median radiation dose and fractions for 3DCRT and IMRT were 54 Gy/30 fr. and 48 Gy/15 fr. The regimens of CRT consisted of weekly gemcitabine 250 mg/m (for 3DCRT) or 1000 mg/m (for IMRT). Acute GI toxicity ≥grade 2 occurred in 32 patients (40%) treated with 3DCRT compared with five patients (19%) treated with IMRT. Late GI toxicity of grade 3 occurred in 10 patients (12%) treated with 3DCRT and one patient (4%) treated with IMRT. Patients who underwent IMRT had superior 1-year LRPFS (73.1% vs. 63.2%, p = 0.035) and 1-year OS (92.3% vs. 68.2%, p = 0.037) as compared with those treated with 3DCRT. Multivariate analysis showed that in IMRT patients, higher dose (≥45 Gy) was an independent factor for better LRPFS and OS. CONCLUSIONS: LAPC patients treated with hypofractionated full-dose gemcitabine IMRT had improved OS and LRPFS without increased GI toxicities when compared to those of patients treated with conventionally fractionated low dose gemcitabine 3DCRT. In IMRT patients, higher dose was an independent favorable prognostic factor for better LRPFS and OS, which suggests that dose escalation with IMRT for LAPC is a promising strategy.
背景：本研究旨在回顾性评估调强放疗（IMRT）与三维适形放疗（3DCRT）治疗局部晚期胰腺癌（LAPC）的胃肠道（GI）毒性和结局。
方法：我们纳入了 2001 年 9 月至 2015 年 3 月期间接受 CRT 治疗的 107 例 LAPC 患者；其中 80 例接受 3DCRT，27 例接受 IMRT。比较两组 GI 毒性、局部无进展生存期（LRPFS）、无远处转移生存期（DMS）和总生存期（OS）。
结果：3DCRT 和 IMRT 的中位放疗剂量和分割次数分别为 54Gy/30 次和 48Gy/15 次。CRT 方案包括每周吉西他滨 250mg/m（用于 3DCRT）或 1000mg/m（用于 IMRT）。3DCRT 治疗的 32 例（40%）患者发生≥2 级急性 GI 毒性，而 IMRT 治疗的 5 例（19%）患者发生。3DCRT 治疗的 10 例（12%）患者和 IMRT 治疗的 1 例（4%）患者发生 3 级迟发性 GI 毒性。与 3DCRT 相比，接受 IMRT 的患者 1 年 LRPFS（73.1%比 63.2%，p=0.035）和 1 年 OS（92.3%比 68.2%，p=0.037）均有显著改善。多因素分析显示，在 IMRT 患者中，更高剂量（≥45Gy）是 LRPFS 和 OS 更好的独立因素。
结论：与接受常规分割低剂量吉西他滨 3DCRT 的患者相比，接受全剂量低分次吉西他滨 IMRT 治疗的 LAPC 患者具有更好的 OS 和 LRPFS，且胃肠道毒性无增加。在 IMRT 患者中，更高的剂量是 LRPFS 和 OS 更好的独立预后因素，这表明 LAPC 的 IMRT 剂量升级是一种很有前途的策略。
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