Wu Lili, Zhou Yuhong, Fan Yue, Rao Shengxiang, Ji Yuan, Sun Jing, Li Tingting, Du Shisuo, Guo Xi, Zeng Zhaochong, Lou Wenhui
Department of Radiotherapy, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.
Department of Medical Oncology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.
Front Oncol. 2020 Jan 21;9:1543. doi: 10.3389/fonc.2019.01543. eCollection 2019.
To evaluate the efficacy and tolerability of consolidative chemoradiotherapy (cCRT) after induced chemotherapy (iCT) for locally advanced pancreatic cancer (LAPC). Patients with LAPC were enrolled from January 2013 to November 2018. In stage one, all patients received iCT. Those without distant metastasis proceeded to stage two, received 50.4 Gy cCRT with S-1 as radiosensitizer. Efficacy and tolerability were evaluated in all patients. Sixty-five patients enrolled into this study and accepted iCT. Eleven (16.9%) patients got early progressions or declined general condition, 1 (1.5%) patient quit the trial after one cycle of iCT. These 12 patients didn't receive cCRT. The remaining 53 (81.5%) patients received cCRT. After cCRT, 4 of 53 (7.5%) patients accepted radical resection. The treatment was well-tolerated. In stage one, neutropenia and thrombocytopenia were the most frequent toxicities, the severe toxicity (grade 3 and 4) were 26.2 and 20.0%, respectively. In stage two, fatigue (45.3%) and nausea (41.5%) were the most frequent toxic effects but most were mild. The median overall survival (OS) of whole group was 18.1 months [95% CI, 15.11-21.03 months]. The OS of patients with early progression and patients accepted cCRT were 7.6 months [95% CI, 5.22-10.02 months] and 19.5 months [95% CI, 18.08-20.95 months], respectively ( < 0.001). The PFS of the 53 patients was 10.3 months [95% CI, 8.54-11.96 months] and survival rates at 1- and 2- years were 84.8 and 24.3%, respectively. The current results indicate that iCT is a useful screening method to selecting LAPC patients with less-aggressive biological behavior. cCRT after iCT in patients with LAPC is an optimal treatment. The prognosis of patients who received complete treatment is significantly improved.
评估诱导化疗（iCT）后巩固性放化疗（cCRT）治疗局部晚期胰腺癌（LAPC）的疗效和耐受性。2013年1月至2018年11月纳入LAPC患者。第一阶段，所有患者接受iCT。无远处转移者进入第二阶段，接受以S-1为放射增敏剂的50.4 Gy cCRT。对所有患者评估疗效和耐受性。65例患者纳入本研究并接受iCT。11例（16.9%）患者出现早期进展或全身状况恶化，1例（1.5%）患者在iCT一个周期后退出试验。这12例患者未接受cCRT。其余53例（81.5%）患者接受cCRT。cCRT后，53例患者中有4例（7.5%）接受了根治性切除。治疗耐受性良好。第一阶段，中性粒细胞减少和血小板减少是最常见的毒性反应，严重毒性反应（3级和4级）分别为26.2%和20.0%。第二阶段，疲劳（45.3%）和恶心（41.5%）是最常见的毒性反应，但大多为轻度。全组患者的中位总生存期（OS）为18.1个月[95%CI，15.11 - 21.03个月]。早期进展患者和接受cCRT患者的OS分别为7.6个月[95%CI，5.22 - 10.02个月]和19.5个月[95%CI，18.08 - 20.95个月]（<0.001）。53例患者的无进展生存期（PFS）为10.3个月[95%CI，8.54 - 11.96个月]，1年和2年生存率分别为84.8%和24.3%。目前结果表明，iCT是筛选生物学行为侵袭性较小的LAPC患者的有用方法。LAPC患者iCT后cCRT是最佳治疗方法。接受完整治疗患者的预后显著改善。
