Zhu Xiaofei, Cao Yangsen, Su Tingshi, Zhu Xixu, Ju Xiaoping, Zhao Xianzhi, Jiang Lingong, Ye Yusheng, Cao Fei, Qing Shuiwang, Zhang Huojun
Department of Radiation Oncology, Changhai Hospital Affiliated to Navy Medical University, Shanghai, China.
Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.
Ther Adv Med Oncol. 2020 Dec 14;12:1758835920977155. doi: 10.1177/1758835920977155. eCollection 2020.
This study aims to compare recurrence patterns and outcomes of biologically effective dose (BED, α/β = 10) of 60-70 Gy with those of a BED >70 Gy for locally advanced pancreatic cancer (LAPC).
Patients from three centers with a biopsy and a radiographically proven LAPC were retrospectively included and data were prospectively collected from June 2012 to June 2019. Radiotherapy was delivered by stereotactic body radiation therapy. Recurrences were categorized as in-field, marginal, and outside-the-field recurrence. Patients in two groups were required to receive abdominal enhanced contrast CT or MRI every 2-3 months and CA19-9 examinations every month during follow-up. Treatment-related toxicities were evaluated every month. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method.
After propensity score matching, there were 486 patients in each group. The median prescription dose of the two groups was 37 Gy/5-8 f (range: 36-40.8 Gy/5-8 f) and 42 Gy/5-8 f (range: 40-49.6 Gy/5-8 f), respectively. The median OS of patients with a BED >70 Gy and a BED 60-70 Gy was 20.3 months (95% CI: 19.1-21.5 months) and 18.2 months (95% CI: 17.8-18.6 months) respectively ( < 0.001). The median PFS of the two cohorts was 15.4 months (95% CI: 14.2-16.6 months) and 13.3 months (95% CI: 12.9-13.7 months) respectively ( < 0.001). A higher incidence of in-field and marginal recurrence was found in patients with BED of 60-70 Gy (in-field: 97/486 72/486, = 0.034; marginal: 109/486 84/486, = 0.044). However, more patients with BED >70 Gy had grade 2 or 3 acute (87/486 64/486, = 0.042) and late gastrointestinal toxicities (77/486 55/486, = 0.039) than those with BED of 60-70 Gy.
BED >70 Gy was found to have the best survival benefits along with a higher incidence of acute and late gastrointestinal toxicities. Therefore, a higher dose may be required in the case of patients' good tolerance.
本研究旨在比较局部晚期胰腺癌（LAPC）患者接受60 - 70 Gy生物等效剂量（BED，α/β = 10）与BED > 70 Gy时的复发模式和结局。
回顾性纳入来自三个中心经活检及影像学证实为LAPC的患者，并于2012年6月至2019年6月前瞻性收集数据。采用立体定向体部放射治疗进行放疗。复发分为靶区内复发、边缘复发和靶区外复发。两组患者在随访期间均需每2 - 3个月接受腹部增强CT或MRI检查，每月进行CA19 - 9检测。每月评估治疗相关毒性。采用Kaplan - Meier法估计总生存期（OS）和无进展生存期（PFS）。
倾向评分匹配后，每组有486例患者。两组的中位处方剂量分别为37 Gy/5 - 8 f（范围：36 - 40.8 Gy/5 - 8 f）和42 Gy/5 - 8 f（范围：40 - 49.6 Gy/5 - 8 f）。BED > 70 Gy和BED 60 - 70 Gy患者的中位OS分别为20.3个月（95%CI：19.1 - 21.5个月）和18.2个月（95%CI：17.8 - 18.6个月）（< 0.001）。两个队列的中位PFS分别为15.4个月（95%CI：14.2 - 16.6个月）和13.3个月（95%CI：12.9 - 13.7个月）（< 0.001）。BED为60 - 70 Gy的患者靶区内和边缘复发的发生率更高（靶区内：97/486对72/486，= 0.034；边缘：109/486对84/486，= 0.044）。然而，BED > 70 Gy的患者比BED为60 - 70 Gy的患者有更多2级或3级急性（87/486对64/486，= 0.042）和晚期胃肠道毒性（77/486对55/486，= 0.039）。
发现BED > 70 Gy具有最佳的生存获益，但急性和晚期胃肠道毒性发生率较高。因此，对于耐受性良好的患者可能需要更高的剂量。
