Department of Radiation Oncology, Stanford Cancer Institute, Stanford, USA.
Stanford University School of Medicine, Stanford, USA.
Radiother Oncol. 2020 Nov;152:63-69. doi: 10.1016/j.radonc.2020.07.053. Epub 2020 Aug 5.
We aimed to report the long-term impact of modern chemotherapy and SABR dose regimens on oncologic outcomes of unresectable pancreatic adenocarcinoma (PA).
We reviewed the treatment characteristics and outcomes of all patients who received multi-fraction SABR for unresectable PA between February 2007 and August 2018 at our institution. Time-to-events were calculated from date of diagnosis treating death as a competing risk.
A total of 149 patients were identified. Median follow-up was 15 months (range: 5-47). Median SABR dose was 33 Gy (range: 20-45) delivered in 5 fractions in 143 patients, and 3 or 6 fractions in 6 patients. 107 patients (72%) received gemcitabine-based chemotherapy while 31 (21%) received modified FOLFIRINOX (mFFX). Median OS was 16 months (95% CI, 14-17), with a 1-year cumulative incidence of LF of 14%. The combination of SABR doses ≥40 Gy and mFFX (n = 21) showed a superior PFS and OS to the use of GEM-based chemotherapy with <40 Gy SABR doses (median PFS: 14 vs. 10 months, HR: 0.46, 95% CI: 0.29-0.71, P = 0.003; median OS: 24 vs. 14 months, HR: 0.36, 95% CI: 0.22-0.59, P = 0.002), with 1-year PFS and OS of 67% and 90% compared to 35% and 59% for those who received GEM-based chemotherapy with <40 Gy SABR doses, respectively.
The use of mFFX and a SABR dose ≥40 Gy in 5 fractions may be superior compared to regimens that utilize gemcitabine-based chemotherapy or SABR doses <40 Gy.
本研究旨在报告现代化疗和立体定向消融放疗（SABR）剂量方案对不可切除胰腺腺癌（PA）患者肿瘤学结局的长期影响。
我们回顾了 2007 年 2 月至 2018 年 8 月期间在我院接受多分割 SABR 治疗不可切除 PA 的所有患者的治疗特征和结局。从诊断日期开始计算时间事件，将死亡视为竞争风险。
共纳入 149 例患者。中位随访时间为 15 个月（范围：5-47）。中位 SABR 剂量为 33 Gy（范围：20-45），在 143 例患者中采用 5 次分割，在 6 例患者中采用 3 次或 6 次分割。107 例（72%）患者接受吉西他滨为基础的化疗，31 例（21%）患者接受改良 FOLFIRINOX（mFFX）化疗。中位 OS 为 16 个月（95%CI，14-17），1 年累积 LF 发生率为 14%。SABR 剂量≥40 Gy 联合 mFFX（n=21）的 PFS 和 OS 优于 SABR 剂量<40 Gy 联合吉西他滨为基础化疗（中位 PFS：14 与 10 个月，HR：0.46，95%CI：0.29-0.71，P=0.003；中位 OS：24 与 14 个月，HR：0.36，95%CI：0.22-0.59，P=0.002），1 年 PFS 和 OS 率分别为 67%和 90%，而接受 SABR 剂量<40 Gy 联合吉西他滨为基础化疗的患者分别为 35%和 59%。
与吉西他滨为基础化疗或 SABR 剂量<40 Gy 的方案相比，使用 mFFX 和 5 次分割 SABR 剂量≥40 Gy 的方案可能更具优势。
