125I粒子和125I+吉西他滨在治疗局部进展期胰腺癌中的比较

目的:研究放射性碘-125粒子(125I)和125I+吉西他滨(GEM)在局部进展期间胰腺癌中的应用比较.背景125I近距离治疗曾被尝试应用于治疗晚期胰腺癌,尤其在治疗二、三期的胰腺癌上,拥有一定的优势;GEM是一种对晚期胰腺癌疗效肯定、耐受性好,能明显改善患者生存质量的抗癌药物.然而,125I+GEM的研究尚未见报道,所以,本文将对上述两种疗法进行比较.方法:自2000年4月～2003年4月,38例局部进展期胰腺癌(LAPC)患者随机分成2组:A组18例(125I粒子组),B组20例(125I+GEM).所有患者均于手术中施行了125I粒子植入术.根据MemorialSloan Ketter癌症中心(MSKCC)技术计算出粒子的数目和总活度.每次所用粒子的平均活度、最小周边剂量和治疗靶区大约分别是20mCi,14 000 cGy,53cm3.33例行胆肠和/或胃肠吻合术.在术后,定期行腹部x拍片,CT扫描和放射性核素等检查.结果:例患者中,可评价客观疗效者(OTR)34例,可评价临床受益反应(CBR)者36例,可行毒性反应评价者36例.CR+PR率A组为37.6%,B组为44.5%(P＞0.05),CR,PD中位期A组为8.0个月和3.2个月,B组5.5个月和5.0个月(P＜0.05).CBR率A组为11.7%,B组为42.1%(P＜0.05).两组毒性反应率和并发症率没有差异.12和24个月生产率A组为32.5%,16.3%,B组为61%,38.7%(P=0.04).总的Ⅱ期12、24个月生存率65.4%,36.3%,总的Ⅲ期12、24个月生存率31%,7.9%(P=0.02).结论:125I和125I+GEM在治疗LAPC有一定的客观疗效,但是,125I+GEM比125I能更好地改善LAPC的生存质量,提高LAPC生存率,并且与肿瘤分期相关.

Treatment of Unresectable Carcinoma of Pancreas with 125I Implantation and 125I Plus Gemcitabine

Objective:To study the role of 125I and 125I plus gemcitabine (GEM) in treatment of unresectable carcinoma of pancreas. Methods: From April 2000 to April 2003, 38 untreated patients with locally advanced pancreatic cancer (LAPC) were collected and randomized into two groups: Arm A-125I (18 patients) and Arm B-125I + GEM (20 patients). Eligibility criteria were:cytologically and pathologically proven pancreatic carcinoma, Kamofsky perforrance status (kps) 60-80, age 18-75 years, adequate hematological, renal and liver function, and controllable pain. Arm A patients were treated with 125I implants. Arm B patients started chemotherapy within 10-14 d post-operatively following the implant procedure. Chemotherapy doses were as follows: GEM 1 000 mg/m2 weekly x 3 followed by 1 week of rest for 3 cycles. In addition, all patients underwent laparotomy and surgical staging.The surgical procedures performed were biopsy, gastric bypass and biliary bypass. The total activity and number of seeds used were as recommended by Anderson. The mean activity, minimal peripheral dose (MPD), and volume of implants were 20 mCi, 14 000 cGy, and 53 cm3, respectively. Results:Overall response rate (CR+ PR) in Arm A was 37.6% and in Arm B it was 44.5% ( P ＞ 0.05). PR median duration in Arm A was 6.7 months and in Arm B it was 4.8 months ( P＜ 0.05). Clinical benefit rexponse was experienced by 11.7 % of Arm A compared with 42.1% of Arm B ( P ＜ 0.05). The incidences of hematological toxicity (such as neutropenia) between Arm A and Arm B were 5.8% and 21.1%, respectively ( P＞ 0.05). The survival rates of 12- and 24-month were 32.5%, 16.3% for Arm A and 61%, 38.7% for Arm B ( P= 0.04). The rate of complication of Arm A was lower than that of Arm B without statistical significance. Conclusion:To some extent, 125I or 125I plus GEM is able to lead to a moderate objective response for LAPC with obstructive jaundice on the base of biliary bypass or/and gastric bypass, but 125I plus GEM is more effective than 125I in improvement of the quality of life and survival rate in patients with LAPC.