33例局部晚期胰腺癌三维适形放疗同步卡培他滨化疗的临床观察

胰腺癌是最常见的消化道恶性肿瘤之一,发病率呈逐年上升趋势,仅有10%～15%的病例可行手术切除.对局部晚期胰腺癌,放疗联合化疗已成为主要治疗手段.三维适形放疗技术因其能使肿瘤病灶接受高剂量,而周围正常组织却受量极低,在晚期胰腺癌的放疗中越来越多地被应用.笔者应用三维适形放疗(3DCRT)联合同步卡培他滨口服化疗治疗局部晚期胰腺癌,取得较好疗效,现报道如下.     

重组人血管内皮抑素联合常规化疗、体部立体定向放疗治疗局部晚期胰腺癌的临床观察

目的 观察重组人血管内皮抑素联合常规化疗、体部立体定向放疗治疗局部晚期胰腺癌的有效性和安全性.方法 64例不能手术切除的局部晚期胰腺癌患者接受体部立体定向放疗、吉西他滨+顺铂化疗、重组人血管内皮抑素靶向治疗.治疗后评价疗效和毒副反应.结果 治疗后3个月全组总有效率为73.4%(47/64),生活质量改善率达到78.1%(50/64).全组患者出现的Ⅲ~Ⅳ度毒副反应主要是白细胞减少(4.7%)、血小板减少(7.8%)及恶心呕吐(6.2%),主要与化疗有关.未出现治疗相关性死亡.结论 重组人血管内皮抑素联合吉西他滨+顺铂化疗、体部立体定向放疗治疗局部晚期胰腺癌患者近期疗效较好,毒副反应可耐受,且能提高患者的生存质量,是治疗局部晚期胰腺癌较好的方法.     

局部晚期胰腺癌治疗方式的评价和分析

随着抗肿瘤药物健择的问世和放疗技术的发展，局部晚期胰腺癌的治疗得到更广泛研究。笔者1998年3月至2004年6月采用健择为主联合化疗方案或健择联合三维适形放疗治疗42例局部晚期胰腺癌，现回顾性分析如下。     

胰、脾

16排螺旋CT双期扫描在胰腺癌诊断与术前评估中的应用；薄层细胞涂片在术中诊断胰腺癌的应用价值；胰腺癌术前、术后化疗的疗效；三维适形放疗联合动脉灌注化疗治疗局部晚期胰腺癌的临床疗效观察；三维适形放疗结合区域性动脉灌注化疗治疗局部中晚期胰腺癌的疗效观察。     

三维适形放疗同步奥沙利铂联合吉西他滨化疗治疗局部晚期胰腺癌的临床观察

目的 探讨三维适形放疗(3DCRT)同步奥沙利铂联合吉西他滨化疗治疗局部晚期胰腺癌的疗效和毒副反应.方法 入组局部晚期胰腺癌30例均接受3DCRT,总剂量45.0～50.4 Gy,5～6周内完成.在放疗的同时接受化疗,放疗结束后继续化疗2～4个周期,方案为:奥沙利铂100mg/m2,静脉滴注,d1;吉西他滨1 000 ...     

伽玛刀联合热化疗治疗局部晚期胰腺癌的疗效

背景与目的:放疗及化疗等非手术治疗是局部晚期胰腺癌主要的治疗手段.本研究旨在评价三维立体定向伽玛刀治疗联合热化疗对局部晚期胰腺癌的临床疗效.方法:将2001年12月至2006年1月收治的75例局部晚期胰腺癌患者分为两组,其中37例仅采用单纯放疗,38例在放疗的同时及以后给予热化疗.放疗采用三维立体定向伽玛刀治疗,50%～60%等剂量曲线,单次周边剂量3.0-4.5 Gy,治疗8～12次,热化疗自伽玛刀治疗开始后同步进行.热疗时维持温度41.5-43.5℃,每次1 h.每周2次,共6次.热疗中同时给予替加氟0.6～1.0 g,亚叶酸钙0.2 g静脉滴注.进行4-6次;或伽玛刀治疗同时及治疗后给予吉西他滨0.6-1.0 g/m2d1.8静脉滴注;顺铂20～30 mg/m2 d1-3静脉滴注,每28天重复一次,总疗程3-6周期.结果:治疗后3个月全组总有效率(CR PR)为70.7%(53/75),综合组与单纯放疗组的有效率分别为73.7%、67.6%.全组1年、2年生存率分别为48.3%和22.1%,其中综合组分别为51.2%和26.5%,单纯放疗组分别为45.2%和17.6%.治疗及随访期间未见穿孔、大出血、持续高热等严重并发症.结论:三维立体定向伽玛刀联合热化疗治疗局部晚期胰腺癌患者近期疗效满意,毒副反应可耐受,且能提高患者的生存质量及生存期,是治疗局部晚期胰腺癌较好的方法.     

三维适形放疗联合GP方案化疗治疗局部晚期胰腺癌的临床观察

目的 分析三维适形放疗(3-DCRT)联合GP方案化疗治疗局部晚期胰腺癌的临床疗效.方法 40例局部晚期胰腺癌随机分为2组,治疗组22例给予3-DCRT联合GP方案化疗,对照组18例仅给予3-DCRT,治疗结束后评价临床疗效和毒副反应.结果 治疗组和对照组中位生存期分别为15个月和7个月,差异有统计学意义(P＜0.05).治疗组6个月和12个月生存率分别为86.4％、68.2％,高于对照组的50.0％、33.3％,差异有统计学意义(P均＜0.05).主要毒副反应为胃肠道反应和骨髓抑制,但均较轻.结论 3-DCRT联合GP方案化疗治疗局部晚期胰腺癌安全有效.     

胰、脾

胰腺癌患者血清可溶性Apo-1／Fas水平变化及其临床意义,不同分割剂量适形放疗对胰腺癌的疗效,超声介导腹腔神经节去除治疗胰腺癌疼痛,恶性肿瘤病人胰十二指肠切除术后胰瘘及胆瘘的防治,三维适形放疗同步国产吉西他滨化疗治疗局部晚期胰腺癌,     

高剂量少分次放疗联合白蛋白结合型紫杉醇、替吉奥方案化疗在局部晚期胰腺癌患者中的临床疗效以及安全性评价

目的 研究高剂量少分次放疗联合白蛋白结合型紫杉醇、替吉奥方案化疗在局部晚期胰腺癌患者中的临床疗效以及治疗相关不良反应.方法 选取2018年9月—2020年11月中国科学院合肥肿瘤医院收治的72例局部晚期胰腺癌患者,分为对照组36例和实验组36例,对照组患者给予白蛋白结合型紫杉醇、替吉奥方案化疗,实验组患者在对照组基础上...     

胰腺癌新辅助与辅助放疗进展

新辅助和辅助放疗在胰腺癌中的作用还不明确.对于可切除的胰腺癌首选手术,新辅助放疗只是手术存在困难时的补充;对于交界可切除及局部晚期的胰腺癌,基于化疗基础上联合放疗的新辅助治疗方案,可提高R0切除率并提高局控率;由于现有的临床试验的结果不一致,胰腺癌术后辅助放疗存在争议,但对于非R0切除及pN1的患者,建议在辅助化疗的基...     

Current status of chemoradiotherapy for locally advanced pancreatic cancer in Japan

Although the results of randomized controlled trials for locally advanced pancreatic cancer conducted between 1969 and 1988 demonstrated a survival advantage for concurrent radiotherapy and bolus 5-fluorouracil (FU) injection, the prognosis of patients with this disease remains very poor. In an attempt to improve patient outcome after chemoradiotherapy, various clinical trials for this disease have been conducted in Japan. These trials were designed to evaluate novel chemotherapy regimens combined with conventional radiotherapy, or intensive radiotherapy in combination with chemotherapy. After gemictabine was shown to yield a better survival outcome than 5-FU in patients with advanced disease, this drug was investigated as a chemotherapeutic agent and/or radiosensitizer for locally advanced pancreatic cancer in a number of trials. S-1, a novel oral fluoropyrimidine derivative that appears promising for the treatment of metastatic disease, is also being intensively evaluated in Japan for the treatment of locally advanced pancreatic cancer. In this review, we summarize recent treatment strategies that are being used in Japan with the goal of establishing a new standard therapy for locally advanced pancreatic cancer.     

胰腺癌的治疗进展

外科是胰腺癌惟一可能治愈的手段。放化综合治疗可提高局部晚期患者的中位生存期。抗血管生成是有吸引力的治疗靶标，生物靶向治疗与化疗联合对局部晚期胰腺癌患者有一定的疗效。     

胰腺癌的治疗进展

外科是胰腺癌惟一可能治愈的手段。放化综合治疗可提高局部晚期患者的中位生存期。抗血管生成是有吸引力的治疗靶标,生物靶向治疗与化疗联合对局部晚期胰腺癌患者有一定的疗效。     

晚期胰腺癌调强放疗同步吉西他滨化疗的临床观察

为了评价局部晚期胰腺癌调强放疗同步吉西他滨化疗的临床观察。分析我院2006-09-02-2009-08-02收治的86例局部晚期胰腺癌患者的近期疗效、毒副反应和长期生存率。将所有患者随机分为治疗组(46例)和对照组(40例),其中治疗组,采用调强放疗同步吉西他滨化疗;对照组采用单纯吉西他滨化疗。治疗组和对照组有效率(CR+PR)分别为67.4%和37.5%,近期疗效两组差异有统计学意义,χ2=4.859 8,P=0.023。治疗组和对照组的6个月生存率分别为82.6%和60.0%,P=0.058;12个月生存率分别为60.9%和35.0%,两组间差异无统计学意义,P=0.056。两组的临床获益率(CBR)差异无统计学意义,P=0.058。两组消化系统不良反应差异有统计学意义,P=0.042。初步研究结果提示,调强放疗同步吉西他滨同步化疗治疗局部晚期胰腺癌,在近期疗效方面优于吉西他滨单药治疗,而远期生存率虽有一定的优势,但两者在临床获益方面差异无统计学意义,同步放化疗组消化系统毒副反应有增加的趋势,但在可控制范围内。     

局部进展期胰腺癌的多学科综合治疗

胰腺癌是恶性程度高且预后极差的消化系统肿瘤。对可手术切除的局限性胰腺癌,因其术后局部复发儿率也较高,故建议采用以手术为主的多学科综合治疗。外放射治疗是无法手术胰腺癌的主要治疗手段。对无法切除的局部进展期肿瘤,主要采用局部外放射治疗联合全身化疗的多学科综合治疗。Ⅲ期随机临床研究结果已经证实,同期联合放化疗较单一放射治疗对患者的生存具显著优势。与放射治疗同步应用的化疗药物目前主要包括5-FU、卡培他滨与吉西他滨等。同期联合放化疗中应用多药联合化疗方案可明显增加治疗相关的不良反应,但临床研究结果并未显示多药方案对疗效及患者预后有所助益。放疗技术目前推荐三维适形放射治疗或调强放疗（IMRT）。靶区范围建议包括临床影像检查可见肿瘤外放安全边界,对未被侵及的淋巴引流区域不行预防性照射。IMRT不仅可减低周围正常组织的照射剂量,还可提高肿瘤靶区的照射剂量,实现剂量递增。     

动脉化疗联合三维适形放疗治疗局部晚期胰腺癌的临床疗效

目的探讨动脉化疗联合三维适形放疗治疗局部晚期胰腺癌的疗效和安全性。方法 20例局部晚期胰腺癌采用吉西他滨（1 000 mg/m^2）区域性动脉灌注结合静脉化疗联合三维适形放疗治疗。放疗采用常规分割,1.8～2.0Gy/次,1次/天,5次/周,放疗剂量95%PTV45～50 Gy/25次。结果 20例患者全部完成治疗计划,原发灶完全缓解率为5.0%,部分缓解率为65.0%,总有效率为70.0%。临床获益率为80.0%。中位生存期为13个月,1、2年总生存率分别为56.2%、19.6%。1～2级白细胞下降发生率为80.0%,3级为20.0%;1～2级急性胃肠道反应发生率为90.0%,3级为5.0%。结论区域性动脉灌注化疗联合三维适形放疗是治疗局部晚期胰腺癌的1种有效方法。     

Optimal combination of radiofrequency ablation with chemoradiotherapy for locally advanced pancreatic cancer

Problems have been reported in the treatment of pancreatic cancer with radiofrequency ablation (RFA), such as the friability of the organ itself. This report presents possible solutions to such problems. Although our patient suffered from locally advanced unresectable pancreatic cancer, she remained well at 18 mo after RFA with no evidence of recurrence. To ameliorate the side effects of RFA, after a palliative bypass procedure, the subject was treated with combined radiotherapy and chemotherapy. After this regimen had been administered, a contrast-enhanced computed tomography scan confirmed that RFA is a viable approach to the treatment of pancreatic cancer as the chemoradiotherapy had resulted in marked tumor shrinkage and pancreatic fibrosis; i.e., sufficient tumor ablation was achieved without serious RFA-related complications, such as pancreatitis or pancreatic fistulae. The present case suggests that RFA combined with preceding chemoradiotherapy is safe and effective for the palliative treatment of locally advanced pancreatic cancer.     

The role of radiotherapy in management of pancreatic cancer

Pancreatic cancer is one of the leading causes of cancer death. The treatment options in pancreatic cancer remain limited. This review provides an overview of the role of radiotherapy (RT) alone or in combination with systemic treatment at different settings of treatment strategy. Neoadjuvant chemoradiotherapy (CRT) may downstage the borderline resectable disease and make resection possible, which could translate to a survival benefit. Although the benefit of adjuvant CRT remains controversial due to inconsistent outcome of randomized trials, in North America it is still a common recommendation of the treatment. For locally advanced pancreatic cancer, the treatment option could either be chemotherapy or chemoradiotherapy. By using advanced radiotherapy modalities, the toxicity of RT could be reduced and RT dose escalation becomes possible to improve locoregional control.