Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, Maryland, USA.
Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, Maryland, USA.
Clin Oncol (R Coll Radiol). 2022 Jun;34(6):386-394. doi: 10.1016/j.clon.2021.12.014. Epub 2021 Dec 31.
The purpose of this study was to report on outcomes of a cohort of patients who were treated with reirradiation with stereotactic body radiation therapy (SBRT) for locally recurrent pancreatic adenocarcinoma.
Patients treated with SBRT reirradiation for locally recurrent pancreatic adenocarcinoma from December 2009 to April 2020 were included in the study. Descriptive statistics were used to record patient demographics, tumour and treatment characteristics. Kaplan-Meier analysis was used to evaluate overall survival, local progression-free survival (LPFS), distant metastasis-free survival and progression-free survival (PFS).
In total, 27 patients were included in the study. The median follow-up time from local recurrence was 19.7 months (range 4.2-43.1 months). Most patients received five-fraction SBRT (26/27, 96%). The median overall survival after local recurrence treatment was 18.3 months (range 3.0-42.6 months), with 6-month, 1-year and 2-year overall survival rates of 88.5%, 73.1% and 33.6%. The median LPFS after local recurrence treatment was 16.2 months (range 2.3-33.6 months), with 6-month, 1-year and 2-year LPFS rates of 95.8%, 62.9% and 27.2%. Peri-SBRT chemotherapy improved LPFS (median 17.5 versus 8.5 months; P = 0.010) and overall survival (median 19.3 versus 5.5 months; P = 0.049). Tumours ≤ 3 cm in the greatest dimension showed better local control (median LPFS 19.2 versus 10.2 months; P = 0.130). There was one case (4%) of acute grade 3 pain and one case (4%) of late grade 3 gastrointestinal toxicity.
Reirradiation with five-fraction SBRT is safe, but local control remains suboptimal. Patients with smaller tumours experienced improved outcomes, as did patients whose treatment plan included the administration of peri-SBRT chemotherapy.
本研究旨在报告一组接受立体定向体部放射治疗（SBRT）再放疗的局部复发性胰腺腺癌患者的治疗结果。
纳入 2009 年 12 月至 2020 年 4 月期间因局部复发性胰腺腺癌接受 SBRT 再放疗的患者。采用描述性统计方法记录患者的人口统计学、肿瘤和治疗特征。采用 Kaplan-Meier 分析评估总生存期、局部无进展生存期（LPFS）、远处无转移生存期和无进展生存期（PFS）。
共纳入 27 例患者。从局部复发到随访的中位时间为 19.7 个月（范围为 4.2-43.1 个月）。大多数患者接受五分割 SBRT（26/27，96%）。局部复发治疗后的中位总生存期为 18.3 个月（范围为 3.0-42.6 个月），6 个月、1 年和 2 年的总生存率分别为 88.5%、73.1%和 33.6%。局部复发治疗后的中位 LPFS 为 16.2 个月（范围为 2.3-33.6 个月），6 个月、1 年和 2 年的 LPFS 率分别为 95.8%、62.9%和 27.2%。SBRT 前后化疗可改善 LPFS（中位值 17.5 个月 vs 8.5 个月；P=0.010）和总生存期（中位值 19.3 个月 vs 5.5 个月；P=0.049）。最大直径≤3cm 的肿瘤局部控制更好（中位 LPFS 19.2 个月 vs 10.2 个月；P=0.130）。有 1 例（4%）发生急性 3 级疼痛，1 例（4%）发生晚期 3 级胃肠道毒性。
五分割 SBRT 再放疗安全，但局部控制仍不理想。肿瘤较小的患者和接受 SBRT 前后化疗的患者治疗效果更好。
