Hurmuz Pervin, Cengiz Mustafa, Ozyigit Gokhan, Yuce Sari Sezin, Kahvecioglu Alper, Beduk Esen Caglayan Selenge, Yalcin Suayib, Zorlu Faruk
Radiation Oncology, Hacettepe University Medical School, Ankara, TUR.
Medical Oncology, Hacettepe University Medical School, Ankara, TUR.
Cureus. 2023 Apr 28;15(4):e38255. doi: 10.7759/cureus.38255. eCollection 2023 Apr.
Background Stereotactic body radiotherapy (SBRT) allows the delivery of an ablative radiation dose to the tumor with minimal toxicity. Although magnetic resonance imaging (MRI)-guided SBRT appears to be a promising approach in the modern era, X-ray image-guided SBRT is still used worldwide for pancreatic cancer. This study aims to evaluate the results of X-ray image-guided SBRT in patients with locally advanced pancreatic cancer (LAPC). Methodology Medical records of 24 patients with unresectable LAPC who underwent X-ray image-guided SBRT between 2009 and 2022 were retrospectively evaluated. SPSS version 23.0 (IBM Corp., Armonk, NY, USA) was utilized for all analyses. Results The median age was 64 years (range = 42-81 years), and the median tumor size was 3.5 cm (range = 2.7-4 cm). The median total dose of SBRT was 35 Gy (range = 33-50 Gy) in five fractions. After SBRT, 30% of patients showed complete and 41% showed partial response, whereas 20% had stable disease and 9% had progression. Median follow-up was 15 months (range = 6-58 months). During follow-up, four (16%) patients had local recurrence, one (4%) had a regional recurrence, and 17 (70%) had distant metastasis (DM). The two-year local control (LC), local recurrence-free survival (LRFS), overall survival (OS), and DM-free survival (DMFS) rate was 87%, 36%, 37%, and 29%, respectively. In univariate analysis, a larger tumor size (>3.5 cm) and higher cancer antigen 19-9 level (>106.5 kU/L) significantly decreased the OS, LRFS, and DMFS rates. No severe acute toxicity was observed. However, two patients had severe late toxicity as intestinal bleeding. Conclusions X-ray image-guided SBRT provides a good LC rate with minimal toxicity for unresectable LAPC. However, despite modern systemic treatments, the rate of DM remains high which plays a major role in survival.
背景 立体定向体部放疗（SBRT）能够以最小的毒性向肿瘤输送消融性辐射剂量。尽管磁共振成像（MRI）引导的SBRT在现代似乎是一种很有前景的方法，但X射线图像引导的SBRT在全球范围内仍被用于胰腺癌治疗。本研究旨在评估X射线图像引导的SBRT治疗局部晚期胰腺癌（LAPC）患者的结果。方法 回顾性评估了2009年至2022年间接受X射线图像引导的SBRT的24例不可切除LAPC患者的病历。所有分析均使用SPSS 23.0版（美国纽约州阿蒙克市IBM公司）。结果 中位年龄为64岁（范围=42 - 81岁），中位肿瘤大小为3.5 cm（范围=2.7 - 4 cm）。SBRT的中位总剂量为35 Gy（范围=33 - 50 Gy），分5次给予。SBRT后，30%的患者显示完全缓解，41%显示部分缓解，而20%疾病稳定，9%疾病进展。中位随访时间为15个月（范围=6 - 58个月）。随访期间，4例（16%）患者出现局部复发，1例（4%）出现区域复发，17例（70%）出现远处转移（DM）。两年局部控制（LC）、无局部复发生存率（LRFS）、总生存率（OS）和无远处转移生存率（DMFS）分别为87%、36%、37%和29%。单因素分析中，较大的肿瘤大小（>3.5 cm）和较高的癌抗原19 - 9水平（>106.5 kU/L）显著降低了OS、LRFS和DMFS率。未观察到严重的急性毒性。然而，2例患者出现严重的晚期毒性，表现为肠道出血。结论 X射线图像引导的SBRT为不可切除的LAPC提供了良好的LC率，且毒性最小。然而，尽管有现代的全身治疗，DM率仍然很高，这在生存中起主要作用。
