Roldan G E, Gunderson L L, Nagorney D M, Martin J K, Ilstrup D M, Holbrook M A, Kvols L K, McIlrath D C
Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905.
Cancer. 1988 Mar 15;61(6):1110-6. doi: 10.1002/1097-0142(19880315)61:6<1110::aid-cncr2820610610>3.0.co;2-6.
One hundred fifty-nine patients with unresectable but localized pancreatic cancer, as defined at exploratory laparotomy, were treated at the Mayo Clinic between February 1974 to April 1985. Postoperative therapy consisted of 4000 to 6000 cGy external beam irradiation (XRT) alone in 122 patients or 4500 to 5500 cGy XRT in combination with an intraoperative electron boost in 37. In addition, 132 (both groups) received 5-fluorouracil (5-FU) chemotherapy. Local control (LC) at 1 year was 82% with XRT + intraoperative radiation therapy (IORT) versus 48% with XRT and 66% versus 20% at 2 years respectively (P less than 0.0005). Due to the high incidence of hematogenous and/or peritoneal spread in both groups (abdominal failure in 54 and 56% of patients at risk), the decreased frequency of local progression did not translate into an improved survival. Neither median nor long-term survival of the two treatment groups (XRT versus XRT + IORT) was statistically different (median 12.6 months versus 13.4 months, P = 0.25). With tumor arising in the head of the pancreas, survival at 2 years was 18% as opposed to 0% for other locations (P less than 0.01). On the basis of a Cox multivariate analysis, no other treatment or prognostic factor significantly altered survival. Until the problem with systemic failure (usually abdominal) can be resolved, the median and long-term survival of patients with pancreatic carcinoma is likely to remain unchanged. Since IORT appears to improve local control, we will continue to utilize IORT in phase 1, 2 studies which also attempt to decrease the incidence of abdominal failures. Even with IORT + XRT combinations, the incidence of local progression is excessive and radiation dose modifiers need to be evaluated.
1974年2月至1985年4月期间，梅奥诊所对159例经探查性剖腹术确诊为不可切除但局限期的胰腺癌患者进行了治疗。术后治疗方案为：122例患者仅接受4000至6000 cGy的外照射放疗（XRT），37例患者接受4500至5500 cGy的XRT并联合术中电子束增强放疗。此外，两组中的132例患者接受了5-氟尿嘧啶（5-FU）化疗。1年时，XRT联合术中放疗（IORT）组的局部控制率（LC）为82%，单纯XRT组为48%；2年时分别为66%和20%（P<0.0005）。由于两组血行和/或腹膜转移发生率均较高（有风险患者中腹部失败率分别为54%和56%），局部进展频率的降低并未转化为生存率的提高。两个治疗组（XRT组与XRT+IORT组）的中位生存期和长期生存率均无统计学差异（中位生存期分别为12.6个月和13.4个月，P=0.25）。肿瘤位于胰头时，2年生存率为18%；位于其他部位时为0%（P<0.01）。基于Cox多因素分析，没有其他治疗或预后因素能显著改变生存率。在系统性失败（通常为腹部）问题得到解决之前，胰腺癌患者的中位生存期和长期生存率可能保持不变。由于IORT似乎能改善局部控制，我们将在1期、2期研究中继续使用IORT，这些研究也试图降低腹部失败率。即使采用IORT+XRT联合方案，局部进展发生率仍过高，需要评估放射剂量调节剂。
