Evans D B, Abbruzzese J L, Cleary K R, Buchholz D J, Fenoglio C J, Collier C, Rich T A
Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Int J Radiat Oncol Biol Phys. 1995 Nov 1;33(4):913-8. doi: 10.1016/0360-3016(94)00615-2.
In an effort to reduce relapse in the liver and improve survival in patients with potentially resectable adenocarcinoma of the pancreatic head, we combined whole-liver irradiation with our standard preoperative chemoradiation regimen.
Eleven patients with biopsy-proven, potentially resectable adenocarcinoma of the pancreatic head were treated with 50.4 Gy of external beam irradiation to the pancreas (1.8 Gy/day, 5 days/week) and concurrent continuous infusion 5-fluorouracil (300 mg/m2 per day). The liver was treated with 23.4 Gy on Days 8 through 21 (13 fractions; 1.8 Gy/fraction). Patients, who upon restaging with radiography and computed tomography were considered to have resectable tumors, were subsequently taken to surgery. If, at surgery, tumors were resectable, pancreaticoduodenectomy was performed, and 10 Gy of intraoperative electron-beam radiation therapy was delivered to the bed of the resected pancreas.
All 11 patients completed chemoradiation. Two treatment-related deaths occurred following chemoradiation, prompting premature termination of the study. Of seven patients taken to surgery, four underwent resection. Seven patients have died of disease, five with liver metastases.
Prophylactic hepatic chemoradiation, as given in this study, was associated with two treatment-related deaths and a higher than expected incidence of subsequent liver metastases. Our data do not support the use of this treatment program in patients with adenocarcinoma of the pancreas.
为了降低肝转移率并提高潜在可切除的胰头腺癌患者的生存率，我们将全肝照射与标准术前放化疗方案相结合。
11例经活检证实为潜在可切除的胰头腺癌患者接受了胰腺50.4 Gy的外照射（1.8 Gy/天，每周5天），同时持续输注5-氟尿嘧啶（300 mg/m²/天）。在第8天至第21天对肝脏进行23.4 Gy的照射（13次分割；1.8 Gy/分割）。经影像学和计算机断层扫描重新分期后被认为肿瘤可切除的患者随后接受手术。如果在手术中肿瘤可切除，则进行胰十二指肠切除术，并对切除的胰腺床给予10 Gy的术中电子束放射治疗。
11例患者均完成了放化疗。放化疗后发生了2例与治疗相关的死亡，促使研究提前终止。在7例接受手术的患者中，4例进行了切除。7例患者死于疾病，5例有肝转移。
本研究中给予的预防性肝放化疗与2例与治疗相关的死亡以及随后肝转移发生率高于预期有关。我们的数据不支持在胰腺癌患者中使用该治疗方案。
