立体定向体部放射治疗用于治疗手术切除后局部复发的胰腺癌。
Stereotactic body radiation therapy for the treatment of locally recurrent pancreatic cancer after surgical resection.
作者信息
Reddy Abhinav V, Hill Colin S, Sehgal Shuchi, He Jin, Zheng Lei, Herman Joseph M, Meyer Jeffrey, Narang Amol K
机构信息
Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA.
Department of Surgery, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, MD, USA.
出版信息
J Gastrointest Oncol. 2022 Jun;13(3):1402-1412. doi: 10.21037/jgo-22-38.
BACKGROUND
To report on a cohort of radiation-naïve patients with pancreatic cancer who developed isolated local recurrence following surgical resection and were subsequently treated with stereotactic body radiation therapy (SBRT).
METHODS
Patients with pancreatic cancer who were treated with SBRT for isolated local recurrence after surgical resection were retrospectively reviewed. Clinical outcomes were calculated from completion of SBRT and included overall survival (OS), local progression-free survival (LPFS), distant metastasis-free survival (DMFS), and progression-free survival (PFS). Univariate (UVA) analysis was performed to identify variables associated with clinical outcomes. Kaplan-Meier method was used for survival outcomes. Toxicity was assessed using the Common Terminology Criteria for Adverse Events version 4.0.
RESULTS
From September 2012 to November 2018, a total of 19 patients with localized pancreatic cancer were treated with SBRT for isolated local recurrence after initial surgical resection. No patients had prior radiation. The median biologically effective dose (BED) was 54.8 Gy (range, 37.5-54.8 Gy). Median OS was 17.1 months, with 6-month and 1-year OS rates of 94.4% and 69.6%, respectively. Nine patients (47.4%) developed local failure after SBRT. Pattern of first failure after SBRT was distant in 7 patients (46.7%), local in 5 patients (33.3%), and synchronous distant and local in 3 patients (20.0%). One patient developed local failure after developing distant disease first. Of the 9 local failures, 3 (33.3%) were out-of-field. Median LPFS was 22.2 months, with 6-month and 1-year LPFS rates of 86.9% and 63.2%, respectively. A BED <54.8 Gy was associated with inferior LPFS (1-year, 25.0% 80.2%, P<0.009). Median DMFS and PFS were 15.6 months. There was 1 case (5.3 %) of grade 3 gastric perforation. There were no cases of grade 4-5 toxicity events.
CONCLUSIONS
SBRT for locally recurrent pancreatic cancer after initial curative resection is safe and feasible. A BED <54.8 Gy was significantly associated with inferior local control. Further studies investigating dose escalation and optimal treatment volumes in the locally recurrent setting are warranted.
背景
报告一组未接受过放疗的胰腺癌患者，这些患者在手术切除后出现孤立性局部复发，随后接受了立体定向体部放疗（SBRT）。
方法
回顾性分析接受SBRT治疗手术切除后孤立性局部复发的胰腺癌患者。临床结局从SBRT完成时开始计算，包括总生存期（OS）、局部无进展生存期（LPFS）、远处无转移生存期（DMFS）和无进展生存期（PFS）。进行单因素（UVA）分析以确定与临床结局相关的变量。生存结局采用Kaplan-Meier方法分析。使用不良事件通用术语标准4.0版评估毒性。
结果
2012年9月至2018年11月，共有19例局限性胰腺癌患者在初次手术切除后因孤立性局部复发接受了SBRT治疗。所有患者均未接受过放疗。中位生物等效剂量（BED）为54.8 Gy（范围37.5 - 54.8 Gy）。中位OS为17.1个月，6个月和1年OS率分别为94.4%和69.6%。9例患者（47.4%）在SBRT后出现局部复发。SBRT后首次复发模式为远处转移7例（46.7%），局部复发5例（33.3%），远处和局部同时复发3例（20.0%）。1例患者先出现远处转移后出现局部复发。在9例局部复发中，3例（33.3%）为野外复发。中位LPFS为22.2个月，6个月和1年LPFS率分别为86.9%和63.2%。BED <54.8 Gy与较差的LPFS相关（1年，25.0%对80.2%，P<0.009）。中位DMFS和PFS为15.6个月。有1例（5.3%）3级胃穿孔。无4 - 5级毒性事件发生。
结论
初次根治性切除后局部复发的胰腺癌患者接受SBRT治疗是安全可行的。BED <54.8 Gy与较差的局部控制显著相关。有必要进一步研究局部复发情况下的剂量递增和最佳治疗体积。
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