立体定向体部放射治疗对根治性切除术后局部区域复发性胰腺癌的疗效
Efficacy of stereotactic body radiation therapy for locoregional recurrent pancreatic cancer after radical resection.
作者信息
Ji Xiaoqin, Zhou Bin, Ding Wei, Wang Jiasheng, Jiang Wanrong, Li Yikun, Hu Jun, Sun Xiangdong
机构信息
Department of Radiation Oncology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
出版信息
Front Oncol. 2022 Jul 22;12:925043. doi: 10.3389/fonc.2022.925043. eCollection 2022.
OBJECTIVE
This study aimed to analyze the efficacy and toxicity of stereotactic body radiotherapy (SBRT) for locoregional recurrent pancreatic cancer after radical resection.
METHODS
Patients with locoregional recurrent pancreatic cancer after surgery treated with SBRT in our institution were retrospectively investigated from January 2010 to January 2020. Absolute neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) recorded at pretreatment were analyzed. Endpoints included overall survival (OS), progression-free survival (PFS) and cumulative incidences of local failure (LF) and metastatic failure (MF).
RESULTS
A total of 22 patients received SBRT with a median prescribed dose of 40 Gy (range of 30-50 Gy)/4 to 7 fractions. The median OS of all patients was 13.6 months (95% CI, 9.6-17.5 months). 0-1 performance status (HR 12.10, 95% CI 2.04-71.81, P=0.006) and ≤2.1 pre-SBRT NLR (HR 4.05, 95% CI 1.21-13.59, P=0.023) were significant predictors of higher OS on multivariable analysis. The median progression-free survival (PFS) of the cohort was 7.5 months (95% CI, 6.5-8.5 months). The median time to LF and MF were 15.6 months and 6.4 months, respectively. The rate of MF as a first event was higher than that of first event LF. Pain relief was observed in all patients (100%) 6 weeks after SBRT. In terms of acute toxicity, grade 1 including fatigue (6, 27.3%), anorexia (6, 27.3%), nausea (4, 18.2%) and leukopenia (4, 18.2%) was often observed. No acute toxicity of grade 4 or 5 was observed. In terms of late toxicity, no treatment-related toxicity was found during follow-up.
CONCLUSION
This study showed that SBRT can significantly reduce pain, effectively control local tumor progression, and have acceptable toxicity for patients with locoregional recurrence after radical resection of primary pancreatic cancer. Good performance status and lower pre-SBRT NLR were associated with improved overall survival.
目的
本研究旨在分析立体定向体部放疗（SBRT）对根治性切除术后局部区域复发性胰腺癌的疗效和毒性。
方法
回顾性调查2010年1月至2020年1月在我院接受SBRT治疗的术后局部区域复发性胰腺癌患者。分析治疗前记录的绝对中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）。观察终点包括总生存期（OS）、无进展生存期（PFS）以及局部失败（LF）和远处转移失败（MF）的累积发生率。
结果
共有22例患者接受了SBRT，中位处方剂量为40 Gy（范围30 - 50 Gy）/4至7次分割。所有患者的中位OS为13.6个月（95%CI，9.6 - 17.5个月）。多因素分析显示，0 - 1的体能状态（HR 12.10，95%CI 2.04 - 71.81，P = 0.006）和SBRT前NLR≤2.1（HR 4.05，95%CI 1.21 - 13.59，P = 0.023）是较高OS的显著预测因素。该队列的中位无进展生存期（PFS）为7.5个月（95%CI，6.5 - 8.5个月）。LF和MF的中位时间分别为15.6个月和6.4个月。MF作为首发事件的发生率高于LF作为首发事件的发生率。SBRT后6周，所有患者（100%）均观察到疼痛缓解。在急性毒性方面，经常观察到1级毒性，包括疲劳（6例，27.3%）、厌食（6例，27.3%）、恶心（4例，18.2%）和白细胞减少（4例，18.2%）。未观察到4级或5级急性毒性。在晚期毒性方面，随访期间未发现与治疗相关的毒性。
结论
本研究表明，SBRT可显著减轻疼痛，有效控制局部肿瘤进展，对原发性胰腺癌根治术后局部区域复发患者具有可接受的毒性。良好的体能状态和较低的SBRT前NLR与总生存期改善相关。
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