不可切除胰腺癌患者肿瘤出血的姑息性放疗：一项单中心回顾性研究。

Palliative radiotherapy for tumor bleeding in patients with unresectable pancreatic cancer: a single-center retrospective study.

机构信息

Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, Japan.

Department of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, Japan.

出版信息

Radiat Oncol. 2023 Oct 31;18(1):178. doi: 10.1186/s13014-023-02367-5.

DOI:10.1186/s13014-023-02367-5

PMID:37907912

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10617159/

Abstract

BACKGROUND

Patients with unresectable pancreatic cancer (PC) sometimes experience gastrointestinal bleeding (GIB) due to tumor invasion of the gastrointestinal tract (tumor bleeding); no standard treatment has been established yet for this complication. Palliative radiotherapy (PRT) could be promising, however, there are few reports of PRT for tumor bleeding in patients with unresectable PC. Therefore, we evaluated the outcomes of PRT for tumor bleeding in patients with unresectable PC.

METHODS

We reviewed the medical records of patients with unresectable PC diagnosed at our institution between May 2013 and January 2022, and identified patients with endoscopically confirmed tumor bleeding who had received PRT. PRT was administered at a total dose of 30 Grays (Gy) in 10 fractions, 20 Gy in 5 fractions, or 8 Gy in a single fraction, and the dose selection was left to the discretion of the attending radiation oncologists.

RESULTS

During the study period, 2562 patients were diagnosed as having unresectable PC at our hospital, of which 225 (8.8%) developed GIB. Among the 225 patients, 63 (2.5%) were diagnosed as having tumor bleeding and 20 (0.8%) received PRT. Hemostasis was achieved in 14 of the 20 patients (70%) who received PRT, and none of these patients developed grade 3 or more adverse events related to the PRT. The median time to hemostasis was 8.5 days (range 7-14 days). The rebleeding rate was 21.4% (3/14). The median hemoglobin level increased significantly (p < 0.001) from 5.9 to 9.1 g/dL, and the median volume of red blood cell transfusion tended (p = 0.052) to decrease, from 1120 mL (range 280-3360 mL) to 280 mL (range 0-5560 mL) following the PRT. The median overall survival (OS) was 52 days (95% confidence interval [CI] 39-317). Of the 14 patients in whom hemostasis was achieved following PRT, chemotherapy could be started/resumed in seven patients (50%), and the median OS in these patients was 260 days (95% CI 76-not evaluable [NE]). Three patients experienced rebleeding (21.4%), on days 16, 22, and 25, after the start of PRT.

CONCLUSION

This study showed that PRT is an effective and safe treatment modality for tumor bleeding in patients with unresectable PC.

摘要

背景

由于肿瘤侵犯胃肠道，部分不可切除的胰腺癌（PC）患者会出现胃肠道出血（GIB）；对于这种并发症，尚未建立标准的治疗方法。姑息性放疗（PRT）可能有一定效果，但关于不可切除 PC 患者肿瘤出血的 PRT 报道较少。因此，我们评估了 PRT 治疗不可切除 PC 患者肿瘤出血的疗效。

方法

我们回顾了 2013 年 5 月至 2022 年 1 月期间在我院诊断为不可切除 PC 的患者的病历，并确定了经内镜证实为肿瘤出血且接受过 PRT 的患者。PRT 的总剂量为 30 戈瑞（Gy），分为 10 个剂量；20 Gy，分为 5 个剂量；或 8 Gy，单次剂量。剂量选择由主治放射肿瘤学家决定。

结果

在研究期间，我院共诊断 2562 例不可切除 PC 患者，其中 225 例（8.8%）出现 GIB。在这 225 例患者中，63 例（2.5%）被诊断为肿瘤出血，20 例（0.8%）接受了 PRT。接受 PRT 的 20 例患者中，有 14 例（70%）止血成功，没有患者发生与 PRT 相关的 3 级及以上不良事件。中位止血时间为 8.5 天（范围 7-14 天）。再出血率为 21.4%（3/14）。血红蛋白水平显著升高（p<0.001），从 5.9 g/dL 升高至 9.1 g/dL；接受 PRT 后，红细胞输注量呈下降趋势（p=0.052），从 1120 mL（范围 280-3360 mL）降至 280 mL（范围 0-5560 mL）。中位总生存期（OS）为 52 天（95%置信区间[CI]：39-317）。接受 PRT 后止血的 14 例患者中，有 7 例（50%）能够开始/恢复化疗，这些患者的中位 OS 为 260 天（95%CI：76-NE）。其中 3 例患者在 PRT 开始后第 16、22 和 25 天出现再出血（21.4%）。