同步整合加量调强放疗联合或不联合诱导化疗的同步放化疗用于局部晚期胰腺癌的有效性和可行性
Effectiveness and feasibility of concurrent chemoradiotherapy using simultaneous integrated boost-intensity modulated radiotherapy with and without induction chemotherapy for locally advanced pancreatic cancer.
作者信息
Oh Eun Sang, Kim Tae Hyun, Woo Sang Myung, Lee Woo Jin, Lee Ju Hee, Youn Sang Hee, Han Sung Sik, Park Sang Jae, Kim Dae Yong
机构信息
Proton Therapy Center, National Cancer Center Research Institute and Hospital, National Cancer Institute, Goyang, Korea.
Center for Liver Cancer, National Cancer Center Research Institute and Hospital, National Cancer Institute, Goyang, Korea.
出版信息
Radiat Oncol J. 2018 Sep;36(3):200-209. doi: 10.3857/roj.2018.00073. Epub 2018 Sep 30.
PURPOSE
To evaluate the effectiveness and feasibility of chemoradiotherapy (CRT) using simultaneous integrated boost-intensity modulated radiotherapy (SIB-IMRT) in locally advanced pancreatic cancer (LAPC) patients.
MATERIALS AND METHODS
Between January 2011 and May 2015, 47 LAPC patients received CRT using SIB-IMRT. Prior to SIBIMRT, 37 patients (78.7%) received induction chemotherapy (IC-CRT group) and remaining 10 patients (21.3%) did not received induction chemotherapy (CRT group). During SIB-IMRT, all patients received concomitant chemotherapy, with gemcitabine (n = 37) and capecitabine (n = 10).
RESULTS
At the time of analysis, 45 patients had died and 2 patients remained alive and the median follow-up time was 14.2 months (range, 3.3 to 51.4 months). For all patients, the median times of local progression-free survival (LPFS), progression-free survival (PFS), and overall survival (OS) were 18.1, 10.3, and 14.2 months, respectively. The median time of LPFS between IC-CRT and CRT groups was similar (18.1 months vs. 18.3 months, p = 0.711). IC-CRT group had a higher trend in PFS (10.9 months vs. 4.1 months, p = 0.054) and had significantly higher OS (15.4 months vs. 9.5 months, p = 0.007) than CRT group. In multivariate analysis, the use of induction chemotherapy and tumor response were significant factors associated with OS (p < 0.05, each). During SIBIMRT, toxicity of grade ≥3 was observed in 7 patients (14.9%) in all patients.
CONCLUSION
CRT using SIB-IMRT is feasible and promising in LAPC patients.
目的
评估同步整合加量调强放疗（SIB-IMRT）在局部晚期胰腺癌（LAPC）患者中进行放化疗（CRT）的有效性和可行性。
材料与方法
2011年1月至2015年5月期间，47例LAPC患者接受了采用SIB-IMRT的CRT。在SIB-IMRT之前，37例患者（78.7%）接受了诱导化疗（IC-CRT组），其余10例患者（21.3%）未接受诱导化疗（CRT组）。在SIB-IMRT期间，所有患者均接受了同步化疗，其中吉西他滨（n = 37）和卡培他滨（n = 10）。
结果
在分析时，45例患者死亡，2例患者存活，中位随访时间为14.2个月（范围3.3至51.4个月）。所有患者的局部无进展生存期（LPFS）、无进展生存期（PFS）和总生存期（OS）的中位时间分别为18.1个月、10.3个月和14.2个月。IC-CRT组和CRT组之间LPFS的中位时间相似（18.1个月对18.3个月，p = 0.711）。IC-CRT组的PFS有更高的趋势（10.9个月对4.1个月，p = 0.054），且OS显著高于CRT组（15.4个月对9.5个月，p = 0.007）。在多变量分析中，诱导化疗的使用和肿瘤反应是与OS相关的显著因素（各p < 0.05）。在SIB-IMRT期间，所有患者中有7例（14.9%）观察到≥3级毒性。
结论
采用SIB-IMRT的CRT在LAPC患者中是可行且有前景的。
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