术中放疗与健择治疗晚期胰腺癌的临床价值

回顾分析术中放疗与健择化疗，配合术后放疗治疗不能手术切除的晚期胰腺癌。18例患者中分为单纯术中放疗（A）组，术中放疗加术后放疗（B）组，术中放疗加术后放疗加健择化疗（C）组，结果 A组中位生存期7.5个月，B组中位生存期13.5个月，C组中位生存期15个月。组间比较C组中位生存期明显高于A、B经组，提示术中放疗在直视下对准肿瘤，一次大剂量照射，加术后补充外照射，肿瘤得到最大剂量杀死，正常组织得到保护，配和健择新药化疗，明显提高中位生存期，在治疗晚期胰腺癌中有较好的临床应用价值。     

42例晚期胰腺癌的术中放射治疗

目的　探讨姑息性手术结合术中放射治疗对晚期胰腺癌的疗效。方法　对 4 2例未能切除的晚期胰腺癌患者进行姑息性手术合并术中放疗。用 9～ 16MeV电子线在直视下照射病灶区域 ,照射量 2 0～ 30Gy。同时与未行术中放疗的 5 9例患者进行对比。结果　术中放疗组患者腹痛和腰背痛完全缓解率为 6 6 .7% ,部分缓解率为 2 6 .2 % ,总有效率为 92 .9%。未行术中放疗的 5 9例患者腹痛和腰背痛完全缓解率为 15 .3% ,部分缓解率为 2 5 .4 % ,总有效率为 4 0 .7% (P <0 .0 0 1)。术中放疗组平均生存期为 16 .7个月 ,对照组为 11.9个月 (P >0 .0 5 )。结论　姑息性手术结合术中放疗能够有效地控制晚期胰腺癌患者的腹痛和腰背痛 ,改善生活质量 ,并可适当延长生存期。     

三维适形放射治疗局部晚期胰腺癌12例疗效观察

[目的]探讨三维适形放射治疗对局部晚期胰腺癌的疗效：[方法]26例局部晚期胰腺癌随机分成治疗组12例，对照组14例。治疗组使用三维适形放射治疗，Dv50Gy-60Gy／25～30f．35～42d：对照组使用常规放射治疗，两组总剂量及分割剂量相同，分割剂量2Gv。[结果]治疗组和对照组放射治疗后1个月疼痛缓解率分别为100％（12／12）和64．29（9／14）（x^2=5．31，P〈0．05）；治疗组和对照组肿瘤退缩率分别为83．33％（10／121和35．71％（5／14）（x^2=6．00，P〈0．01）；中位生存期13．5个月，治疗组和对照组2年生存率分别为41．67％（5／12）和7．14％（1／14）（x^2=4．34，P〈0．05）。[结论]三维适形放射治疗局部晚期胰腺癌，能提高患者的生存质量，延长生存期。     

术中放疗与健择治疗晚期胰腺癌的临床价值

回顾分析术中放疗与健择化疗 ,配合术后放疗治疗不能手术切除的晚期胰腺癌。 18例患者中分为单纯术中放疗 (A)组 ,术中放疗加术后放疗 (B)组 ,术中放疗加术后放疗加健择化疗 (C)组。结果A组中位生存期 7 5个月 ,B组中位生存期 13 5个月 ,C组中位生存期 15个月。组间比较C组中位生存期明显高于A、B组。提示术中放疗在直视下对准肿瘤 ,一次大剂量照射 ,加术后补充外照射 ,肿瘤得到最大剂量杀死。正常组织得到保护 ,配和健择新药化疗 ,明显提高中位生存期 ,在治疗晚期胰腺癌中有较好的临床应用价值。     

125I放射性粒子植入治疗无法手术切除的胰腺癌疗效分析

目的：探讨^125I放射粒子植入术治疗手术无法切除的胰腺癌的治疗疗效。方法：选择胰腺癌患者50例,内放射治疗组30例,肿瘤内部^125I放射粒子植入,有梗阻症状者,加行胆-肠吻合术和胃-空肠吻合术;对照组20例,均行单纯剖腹探查或胆-肠吻合术和（或）胃-空肠吻合术。观察肝肾功能和总胆红素变化、肿瘤大小变化、并发症发生情况、腹痛和背痛变化等。结果：两组患者总胆红素术后4周时均接近正常,肝功能明显改善,手术前后比较差异均有统计学意义;粒子植入组患者手术前后腹痛和腰痛明显改善。有效率100％（30／30）,完全缓解率97％;粒子植入组肿瘤直径有缩小趋势,对照组无明显变化;两组患者均无吻合口瘘、胆瘘、胰瘘、腹腔出血和腹腔感染。结论：^125I粒子植入对不可切除的胰腺癌具有确定疗效,不仅可以明显延长患者生存期,提高生活质量,而且对胰腺癌引起的疼痛有明显的缓解效果。     

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

背景与目的：综合治疗肿瘤是目前的趋势，三维适形放射治疗（3D—CRT）是较新的放疗技术，本文观察：维适形放射治疗（3D—CRT）联合国产吉西他滨化疗治疗局部晚期胰腺癌的耐受性及疗效。方法：36例局部晚期胰腺癌患者进入三维适形放射治疗联合吉西他滨化疗组，全部患者均行吉西他滨化疗，方案为每周1次吉西他滨250mg／m^2.36例患者分别完成3～7个周期的化疗。同步行3D—CRT，计划照射剂量8MV—X线DT65～70Gy．2～2．5Gy／次，1次／天，5天／N结果：36例患者全部完成治疗计划，胰腺痛原发灶完全缓解率（CR）为2．8％（1／36），部分缓解率（PR）为27．8％（10／36），总有效率（CR＋PR）为30．6％（11／36），无变化和进展（NC＋PD）占69．4％（25／36），白细胞下降发生率为91．7％（33／36）疼痛缓解率为90．3％。36例患者的中位随访期为24（12～29）个月。1年及2年生存率分别为36．1％（13／36）和19．4％（7／36）结论：三维适形放射治疗同步吉西他滨化疗治疗局部晚期胰腺癌疗效较好，能明显提高患者的生活质量和生存期，不良反应能为大多数患者耐受，是治疗局部晚期胰腺癌的较好方法。     

立体定向放射治疗胰腺癌112例疗效观察

目的：探讨立体定向放射治疗对胰腺癌的治疗作用。方法：对112例胰腺癌患者实施立体定向伽玛刀治疗,50％剂量曲线DT3．2—3．5Gy,8—10次,3f／w。放疗后随访。结果：患者治疗后3个月至18个月复查cT或MRI提示,胰腺肿瘤区均有所缩小,肿瘤局控率（CR＋PR）87％（92／106）,82例患者腰背部疼痛缓解98％（81／82）。13例不完全梗阻性黄疸症状全部消失,缓解率100％。结论：对于胰腺肿瘤患者,采用立体定向精确放射治疗后可以延长生存期,提高生活质量。     

39例晚期胰腺癌立体定向适形放疗的疗效观察

目的探讨立体定向适形放射治疗晚期胰腺癌的疗效。方法39例晚期胰腺癌患者（Ⅲ期30例，Ⅳ期9例），采用立体定向适形放疗技术，每次照射4～5Gy，9～13次完成（隔日1次），总剂量平均为45Gy（36-52Gy）。结果治疗结束后，上腹及腰背部疼痛完全缓解者11例（36．7％），部分缓解17例（56．7％），2例无明显缓解；CR12例（30．8％），PR16例（41．O％），71．8％（28／39）的病例病灶明显缩小；中位生存期11．4月，1年累计生存率为19．2％（5／26）。生存最长者达18个月。结论立体定向适形放射治疗晚期胰腺癌，能改善患者生存质量，延长生存期。     

立体定向放射治疗联合吉西他滨与吉西他滨单药治疗局部晚期胰腺癌疗效比较

  [摘要]　　　目的 评价立体定向放射治疗联合吉西他滨与吉西他滨单药治疗局部晚期胰腺癌的疗效。方法 对治疗组56例胰腺癌患者行立体定向放射治疗(总剂量4000~4500CGY,10次分割)联合盐酸吉西他滨单药化疗(500mg/m2第1、8天)。对照组50例仅行盐酸吉西他滨单药化疗（500mg/m2第1、8、15天）。结果[给出各项主要数据] 治疗结束2个月CT复查,治疗组及化疗组局部控制率分别为98%、78%（P<0.05）,疼痛控制率分别为67%、17%（P<0.05）。治疗组中位PFS为14个月,较化疗组7.5个月明显延长（P<0.05）。治疗组与化疗组中位生存期分别为15.8、13.2个月（P>0.05）。结论 立体定向放射治疗联合吉西他滨治疗局部晚期胰腺癌较单纯化疗组近期疾病控制率较高,能延长患者无病生存期,显著提高患者的生存质量。     

高能聚焦超声治疗晚期胰腺癌的临床疗效观察（附21例）

目的：观察高强度体外聚焦超声（HIFU）治疗晚期胰腺癌的安全性及临床疗效。方法：2007年9月-2009年3月我科应用FEP—BY02肿瘤超声治疗机治疗晚期胰腺癌21例,共接受治疗235次（每例平均11次）。结果：临床受益率（CBR）80．95％,中位生存时间（MST）6个月。癌性疼痛缓解率86．67％。结论：HIFU单独治疗晚期胰腺癌能取得一定的临床疗效,是一种值得临床推广的治疗手段。     

High dose, external beam and intraoperative radiotherapy in the treatment of resectable and unresectable pancreatic cancer

Ninety patients with pancreatic cancer were treated by external beam radiotherapy (EBRT) and/or intraoperative radiotherapy (IORT) with or without surgical resection of the tumor, and the results were compared with those of a historical control comprising 112 patients treated by surgery alone. At an early stage of this study, postoperative EBRT (50-60 Gy) or IORT (25-33 Gy) was given alone, but recently the two modalities have been combined. The combination of high doses of EBRT and IORT was well tolerated provided that the gastrointestinal tract was not irradiated during IORT. Although EBRT plus IORT appeared to yield better results than either EBRT or IORT alone, the difference was not significant on multivariate analysis, and patients receiving EBRT, IORT, or EBRT + IORT were grouped together. Patients receiving radiotherapy in addition to macroscopically curative surgery had a slightly longer median survival time (14 months) than those receiving curative surgery alone (10 months), but the 3-year survival rate was similar (21% vs. 19%). In patients who underwent noncurative resection, the median survival time was significantly longer for the irradiated group (12 months) than for the control group (6.5 months). Also, in patients with unresectable lesions but no distant metastases, irradiation prolonged the median survival time significantly (8 vs. 3.5 months). In this group, there was one 5-year survivor, who received EBRT of 55 Gy plus IORT of 30 Gy to his unresectable pancreatic body lesion. Patients with metastases were also treated for palliation of symptoms, but it was found that irradiation prolonged the median survival time even in such cases (4.5 vs. 2.5 months). Based on these results, we plan to use EBRT plus IORT in all pancreatic cancer patients with no metastases.     

Radiation therapy of pancreatic cancer]

We have been using external beam radiotherapy (EBRT) and intraoperative radiotherapy (IORT) for both resectable and unresectable pancreatic cancer patients. EBRT (50-60 Gy) was combined with IORT (25-33 Gy) whenever possible, but otherwise EBRT or IORT was given alone. In patients with unresectable tumor but no distant metastasis, the median survival time (MST) was 7.5 months (M) for the EBRT group and 9 M for the EBRT+IORT group. These MST's were significantly longer than the MST of 3 M of patients who had been treated without radiation (historical control). In non-Stage IV patients undergoing non-curative resection, the MST was 12.5 M for the EBRT group, 15.5 M for the EBRT+IORT group, and 7 M for the historical control. In patients undergoing macroscopic curative resection, the MST was 14 M for the EBRT group, 10 M for the EBRT+IORT group, and 10.5 M for the historical control. In Stage IV patients (with distant metastasis), the MST was 4.5 M for the EBRT group, 4 M for the EBRT+IORT group, 2 M for the IORT group, and 2.5 M for the historical control. Thus, radiotherapy appeared useful especially in non-Stage IV patients undergoing non-curative or no resection. A decrease or relief of pain was obtained in 90% of patients with unresectable lesions. Radiotherapy seems to play an important role in the treatment of pancreatic cancer but more aggressive combined treatment seems to be necessary to further improve the dismal prognosis of pancreatic cancer patients.     

Intraoperative and conformal external-beam radiation therapy with protracted 5-fluorouracil infusion in patients with locally advanced pancreatic carcinoma

BACKGROUND: Chemoradiotherapy is widely used for patients with locally advanced pancreatic carcinoma. The purpose of this study was to clarify the efficacy and feasibility of chemoradiotherapy with more intensive radiotherapy in these patients, using a combination of intraoperative radiotherapy (IORT), conformal external-beam radiaotherapy (EBRT), and protracted 5-fluorouracil (5-FU). METHODS: Thirty patients with unresectable locally advanced pancreatic carcinoma were enrolled in this Phase II study. The treatment consisted of IORT (25 grays [Gy]), followed by EBRT (40 Gy in 20 fractions, 5 times per week), and concurrent protracted 5-FU infusion (200 mg/m(2)), beginning 2-4 weeks after IORT. The authors evaluated the efficacy and adverse effects of this treatment by following up patients for 12.0-28.1 months. Survival from the date of IORT was calculated using the Kaplan-Meier method. RESULTS: In 11 of the 30 patients, metastatic spread was detected in the abdominal cavity at laparotomy. The full EBRT dose was administered in 28 of the 30 patients. Of the remaining 2 patients, EBRT was terminated at 8 Gy due to progression of brain metastasis and another patient did not receive EBRT or chemotherapy due to massive ascites after IORT. The overall response rate for primary pancreatic tumor on dynamic computed tomography scan was 23.3% (7 partial responses). Grade 3 or 4 toxicity (according to the National Cancer Institute Common Toxicity Criteria) was observed in 15 of the 28 patients who received the full irradiation dose (53.6%). These included anorexia, nausea, emesis, fatigue, leukopenia, and/or elevation of transaminase levels. There were no directly treatment-related deaths, but 1 patient died of hepatic failure related to late effects of irradiation after 25.6 months. The median survival time of the 30 patients was 7.8 months and the 2-year survival rate was 8.1%. The median survival time of the 19 patients without metastatic spread in the abdominal cavity was 12.9 months and that of the 11 patients with metastatic spread was 5.8 months. CONCLUSIONS: The present regimen of chemoradiotherapy is not superior to conventional chemoradiotherapy (EBRT and 5-FU) for patients with locally advanced pancreatic carcinoma.     

High-dose intraoperative radiotherapy for unresectable pancreatic cancer

PURPOSE: The results of high-dose intraoperative radiotherapy (IORT) and/or external beam radiotherapy (EBRT) for unresectable pancreatic cancer were analyzed to evaluate the possible advantages of IORT in combination with EBRT. METHODS AND MATERIALS: Between 1983 and 1993, 115 patients with unresectable adenocarcinoma of the pancreas (53 with non-Stage IV disease and 62 with Stage IV disease) were treated with EBRT + IORT (55 patients), EBRT alone (44 patients), or IORT alone (16 patients). In non-Stage IV patients, the use of EBRT alone was due to the unavailability of IORT and the use of IORT alone was due to refusal of EBRT. The IORT dose was 30-33 Gy and the EBRT dose was 40-60 Gy. A historical control group comprised of 101 patients undergoing palliative surgery alone was also analyzed. RESULTS: Both non-Stage IV and Stage IV patients receiving EBRT with or without IORT had a better prognosis than the nonirradiated historical controls. Among non-Stage IV patients, the median survival of the EBRT + IORT group (8.5 months) and the EBRT group (8 months) was similar, although survival from 12 to 18 months was higher in the former group (38% vs. 10% at 12 months, p = 0.018, and 19% vs. 0% at 18 months, p = 0.023). In Stage IV patients, the prognosis was not influenced by the type of radiotherapy. Multivariate analysis revealed that a pretreatment carbohydrate antigen (CA) 19-9 level < 1000 U/ml was associated with better survival. In non-Stage IV patients with a CA 19-9 level < 1000 U/ ml, EBRT + IORT appeared to produce a better survival than EBRT alone (p = 0.047). This was supported by multivariate analysis. CONCLUSION: High-dose IORT + EBRT may be more effective than EBRT alone in patients with unresectable but localized pancreatic cancer and a low CA 19-9 level.     

Analysis of the clinical benefit of intraoperative radiotherapy in patients undergoing macroscopically curative resection for pancreatic cancer

PURPOSE: To determine the survival of pancreatic cancer patients treated with intraoperative radiotherapy (IORT) and/or external beam radiation therapy (EBRT) following macroscopically curative resection. METHODS AND MATERIALS: One hundred and thirty-eight patients with pancreatic cancer who had undergone potentially curative total or regional pancreatectomy between 1980 and 1997 were retrospectively analyzed. Among the 138 patients, 98 had a pathologically negative surgical margin and the remaining 40 patients had a positive surgical margin. The usual EBRT dose was 45-55 Gy with a daily fraction of 1.5-2.0 Gy. The median IORT dose was 25 Gy in a single fraction. RESULTS: The 2-year cause-specific survival rate of patients with pathologically negative surgical margins was 19%, and that of patients with positive margins was 4% (p < 0.005). Although the median survival time (MST) of patients with negative margins treated with IORT and EBRT was significantly longer than that of those treated with operation alone (17 vs. 11 months), no significant difference in survival curves was observed. In patients with positive surgical margins in peripancreatic soft tissue, the difference between the survival curve of patients treated with surgery alone and that of those treated with surgery and radiation therapy was borderline significant (p < 0.10). Patients receiving intraarterial or intraportal infusion chemotherapy had significantly improved survival rates compared with those who did not receive it (p < 0.05). CONCLUSION: Although the MST was longer in patients with negative margins receiving IORT and EBRT than in those receiving no radiation, improved long-term survival by IORT and/or EBRT was not suggested. In patients with positive margins, our results obtained by IORT/EBRT were encouraging. Randomized studies with much higher patient numbers are necessary to define the role of IORT in curatively resected pancreatic cancer.     

术中和体外照射治疗晚期胰腺癌

目的 :分析不能手术切除的晚期胰腺癌术中放射 (IORT)和体外放射 (EBRT)治疗的疗效。方法 :回顾我院 1987- 1999年 75例不能手术切除的晚期胰腺癌患者进行单纯IORT、单纯EBRT和IORT加EBRT治疗的临床资料。结果 :单纯IORT、单纯EBRT和IORT加EBRT治疗的 1年生存率分别为15 2 %、14 3%和 31 8% ,IORT加EBRT治疗的结果优于前两者 ,P <0 0 5。结论 :IORT加EBRT治疗可以延长晚期胰腺癌患者的生存期     

术中放疗联合区域动脉灌注治疗晚期胰腺癌

目的 评价术中放疗联合区域动脉灌注治疗晚期胰腺癌的效果。方法 17例晚期胰腺癌减黄手术时行IORT，胃网膜右动脉插管采用5—氟尿嘧啶(5—FU) 表阿霉素(E—ADM) 丝裂霉素(MMC)方案行区域灌注化疗，其中6例术后行外照射放疗。结果 疼痛缓解率70．59％(12／17)，临床受益指数35．29％(6／17)，局部病灶部分缓解23．53％(4／17)。中位生存11个月，1年生存率35．29％(6／17)。结论 IORT结合区域动脉灌注化疗毒副作用轻微，可明显提高临床受益率，延长生存期。     

IORT在不可切除局部晚期胰腺癌治疗中作用

目的 探讨电子线IORT在不可切除局部晚期胰腺癌中的价值。方法 回顾分析2009—2014年本院行电子线IORT的不可切除局部晚期胰腺癌共167例患者的OS期、LR率、不良反应。IORT剂量10~20 Gy。术后12例体外照射、56例同步CRT、17例化疗。Kaplan-Meier法计算生存率,Logrank法检验差异和单因素预后分析,Cox模型多因素预后分析。结果 随访率100%。中位OS期10.3个月,2年OS率为22.0%。中位PFS 6.3个月,2年PFS率为9.9%。CSS期11.2个月,2年CSS率为23.6%。仅行IORT时,<15 Gy、15 Gy和>15 Gy的中位OS及1年OS率分别为6.2个月和10.0%、9.1个月和39.6%、22.2个月和74.4%(P=0.000)。术后辅助治疗模式中IORT+CRT的中位OS期11.6个月,生存最佳(P=0.033)。单因素分析显示IORT剂量、肿瘤大小和限光筒直径为影响预后因素(P=0.000、0.006、0.007),多因素分析显示IORT联合术后放疗、IORT剂量为影响预后因素(P=0.006、0.000)。结论 对于不可切除局部晚期胰腺癌,电子线IORT是安全有效治疗手段,避开胃肠组织前提下适当增加剂量可提高疗效,术后CRT可更好延长生存且不增加不良反应。     

Intraoperative radiotherapy (IORT) for unresectable stage IVb pancreatic cancer

We evaluated the efficacy of IORT for unresectable Stage IVb (Japan Pancreas Society classification) pancreatic cancer. Twelve patients were treated with IORT, 17 with external beam radiotherapy (ERT) and 17 with chemotherapy (CHT, 8 patients doxorubicin-based, 7 patients 5-FU-based). Survival, hospital-free survival and pain relief were compared among the three groups. In the IORT group, 7 patients underwent bypass surgery, 3 celiac plexus blockade, 3 ERT, 2 hyperthermia and 2 CHT. In the ERT group, 1 patient underwent bypass surgery, 7 hyperthermia and 14 CHT. Distant metastases were more frequently found in the CHT group than in the IORT group. Median survival and median hospital-free survival were 208 and 79 days in the IORT group, 125 and 32 days in the ERT group and 76 and 9 days in the CHT group, respectively. Pain relief was obtained in 45% (5/11) of symptomatic patients after IORT and in 27% (4/15) after ERT. No patient (0/13) in the CHT group experienced pain relief. In conclusion, our experience suggests that IORT can reduce pain and improve QOL in patients with unresectable pancreatic cancer.