使用适度低分割调强放疗对交界可切除胰腺癌进行新辅助放化疗：结果及放疗预后因素

Neoadjuvant chemoradiotherapy using moderately hypofractionated intensity-modulated radiotherapy for borderline resectable pancreatic cancer : Outcomes and prognostic radiotherapeutic factors.

作者信息

Iwai Takahiro, Yoshimura Michio, Ono Yuka, Ogawa Ayaka, Ashida Ryo, Masui Toshihiko, Nagai Kazuyuki, Anazawa Takayuki, Kasai Yousuke, Yamane Kei, Hatano Etsuro, Kanai Masashi, Fukuda Akihisa, Isoda Hiroyoshi, Mizowaki Takashi

机构信息

Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

出版信息

Strahlenther Onkol. 2025 Jul 15. doi: 10.1007/s00066-025-02433-9.

DOI:10.1007/s00066-025-02433-9

PMID:40663145

Abstract

PURPOSE

To evaluate the outcome and prognostic factors for borderline resectable pancreatic cancer (BRPC) patients treated with neoadjuvant chemoradiotherapy using moderately hypofractionated intensity-modulated radiotherapy (NAC-MH-IMRT).

METHODS

Patients with BRPC treated with NAC-MH-IMRT at 42 Gy in 15 fractions between February 2013 and June 2021 were evaluated. The overall survival (OS), progression-free survival (PFS), cumulative incidence of locoregional failure and distant metastases, association dose-volume indices, Evans grade for pathological response, and toxicities were evaluated.

RESULTS

A total of 66 patients met the inclusion criteria, and the median follow-up period was 23.9 months. In all, 48 patients underwent pancreatectomy, and margin-negative resection was achieved in 44 patients (91.7%). The median survival and PFS times were 34.8 months and 12.0 months, respectively, for the whole cohort. The 2‑year cumulative incidences of locoregional recurrence and distant metastases in the resected group were 25.7 and 52.8%, respectively. From the Mann-Whitney U test, the minimum dose of the primary gross tumor volume (GTV) of the group with Evans grade ≥ 2b was statistically higher than that of the other group (38.6 Gy vs. 37.3 Gy, p = 0.005). However, this was not associated with reduced cumulative incidence of locoregional failure. No patient had grade ≥ 3 acute gastrointestinal toxicity.

CONCLUSION

NAC-MH-IMRT for BRPC resulted in good survival outcomes and margin-negative resection rates. High GTV was associated with good pathological response; however, improvement of local control requires further investigation.

摘要

目的

评估采用中等分割调强放疗（NAC-MH-IMRT）进行新辅助放化疗的临界可切除胰腺癌（BRPC）患者的治疗结果及预后因素。

方法

对2013年2月至2021年6月期间接受NAC-MH-IMRT、15次分割剂量达42 Gy的BRPC患者进行评估。评估总生存期（OS）、无进展生存期（PFS）、局部区域复发和远处转移的累积发生率、剂量体积指数相关性、病理反应的埃文斯分级及毒性。

结果

共有66例患者符合纳入标准，中位随访期为23.9个月。总计48例患者接受了胰腺切除术，44例患者（91.7%）实现了切缘阴性切除。整个队列的中位生存期和PFS时间分别为34.8个月和12.0个月。切除组2年局部区域复发和远处转移的累积发生率分别为25.7%和52.8%。通过曼-惠特尼U检验，埃文斯分级≥2b组的原发大体肿瘤体积（GTV）最小剂量在统计学上高于另一组（38.6 Gy对37.3 Gy，p = 0.005）。然而，这与局部区域失败累积发生率的降低无关。没有患者发生≥3级急性胃肠道毒性反应。