Department of Radiation Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
Department of Medical Oncology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
J Cancer Res Clin Oncol. 2020 Feb;146(2):417-428. doi: 10.1007/s00432-019-03066-z. Epub 2019 Oct 30.
This study aimed to evaluate the clinical outcomes, toxicity, and prognostic factors of SBRT combined with gemcitabine plus capecitabine (GEM-CAP) in treating locally advanced pancreatic cancer (LAPC).
A total of 56 patients with LAPC treated with SBRT combined with GEM-CAP were reviewed from October 2010 to October 2016. The median total prescription dose at five fractions was 40 Gy (30-50 Gy). The patients were subjected to two cycles of GEM-CAP before SBRT. GEM-CAP chemotherapy was then offered for four cycles or until disease tolerance or progression. The primary endpoints included overall survival (OS) and progression-free survival (PFS).
The median OS and PFS from the date of diagnosis was 19 (95% CI 14.6-23.4) and 12 months (95% CI 8.34-15.66), respectively. The 1-year and 2-year survival rates were 82.1% and 35.7%, whereas the 1-year and 2-year PFS rates were 48.2% and 14.3%, respectively. The median carbohydrate antigen 19-9-determined PFS time was 11 months (95% CI 5.77-16.24). Multivariate analysis demonstrated that tumor diameter, lymph node metastasis, pre-treatment CA19-9 level, and post-treatment CA19-9 decline were independent prognostic factors (p < 0.05). Acute toxicity was minimal, with two cases (3.6%) experiencing grade 3 duodenal obstruction. No adverse events greater than grade 3 occurred. In late toxicity, three patients (5.4%) developed grade 3 gastrointestinal toxicity and two (3.6%) suffered from perforation caused by grade 4 radiation enteritis and intestinal fistula.
The combination of Cyberknife SBRT and GEM-CAP achieved excellent efficacy with acceptable toxicity for LAPC.
本研究旨在评估立体定向放疗（SBRT）联合吉西他滨+卡培他滨（GEM-CAP）治疗局部晚期胰腺癌（LAPC）的临床疗效、毒性和预后因素。
回顾性分析 2010 年 10 月至 2016 年 10 月期间 56 例接受 SBRT 联合 GEM-CAP 治疗的 LAPC 患者的临床资料。五分割的中位总处方剂量为 40Gy（30-50Gy）。SBRT 前患者接受两个周期的 GEM-CAP 化疗。然后给予 GEM-CAP 化疗四个周期，或直至疾病耐受或进展。主要终点包括总生存期（OS）和无进展生存期（PFS）。
从诊断日期开始，中位 OS 和 PFS 分别为 19（95%CI 14.6-23.4）和 12 个月（95%CI 8.34-15.66）。1 年和 2 年生存率分别为 82.1%和 35.7%，1 年和 2 年 PFS 率分别为 48.2%和 14.3%。CA19-9 测定的 PFS 时间的中位值为 11 个月（95%CI 5.77-16.24）。多因素分析表明，肿瘤直径、淋巴结转移、治疗前 CA19-9 水平和治疗后 CA19-9 下降是独立的预后因素（p<0.05）。急性毒性较小，仅 2 例（3.6%）出现 3 级十二指肠梗阻。无大于 3 级的不良事件发生。晚期毒性方面，3 例（5.4%）发生 3 级胃肠道毒性，2 例（3.6%）因 4 级放射性肠炎和肠瘘引起穿孔。
Cyberknife SBRT 联合 GEM-CAP 治疗 LAPC 疗效显著，毒性可接受。
