立体定向放射治疗胰腺癌剂量递增临床研究

目的通过剂量递增试验探索立体定向放射治疗进展期胰腺癌局部肿瘤提高靶区剂量以及减少周围正常组织照射剂量,并提高疗效的可能性。方法27例局部进展期胰腺癌患者接受同期放化疗。放射治疗分第一阶段予常规放射治疗,剂量30Gy/15次/3周;第二阶段立体定向放射治疗,肿瘤靶区分割剂量4Gy/次,总剂量为20～32Gy,在2周内分5～8次完成。总剂量递增水平:50、54、58、62Gy。在放射治疗过程中,每个治疗日5Fu静脉滴注。结果22例完成治疗计划,分别为52Gy3例、54Gy3例、58Gy3例,62Gy13例,5例退出研究。16例治疗前后CA199值分别为(716±15.6)、255U/ml[t(0.05,15)=2.23,P<0.05)]。16例以疼痛为主的患者减少1/3～1/2的麻醉药品用量,其中6例疼痛症状完全消失。15例患者治疗后卡氏评分有提高。结论局部进展期胰腺癌患者接受立体定向放射治疗并同期应用5Fu化疗增敏,可获得确切的姑息治疗作用;肿瘤剂量62Gy分23次在5周完成,无严重的放射治疗和化疗相关的急性毒性反应。

A clinical study of stereotactic radiotherapy dose escalation in the treatment of progressive pancreatic cancer

Objective To explore the stereotactic radiotherapy dose escolation to increase the target area dose of progressive pancreatic cancer and reduce the radiationdose of circum-normal tissue in order to improve the therapeutic efficacy.Methods 27 cases with local progressire pancreatic cancer were chosed into this clinical trial.After being given 30 Gy/15Fx/3weeks conventional radiotherapy,these patients were given a escalation dose with total dose 20 Gy to 32 Gy within two weeks.The total absorption dose would be 50Gy,54Gy,58Gy,62Gy,5-Fu was given on the day of radiotherapy during the treatment course.Results 22 patients finished the clinical trial with 50Gy(n=3),54Gy(n=3),58Gy(n=3),62Gy(n=13).Among 16 patients,the level of CA19-9 was greatly reduced from 716±15.6U/ ml to 255±16.7 U/ml(t(0.05,15)=2.23,P<0.05) after the trial;analgesic intake were reduced by 1/3-1/2 amount in sixteen patients,and pain disappeared completely in 6 patients.Karnofsky Performance Status were greatly improved in 15 patients.Conclusions For patients with local progressire pancreatic cancer,stereotactic radiotherapy combined with conventional external radiotherapy with a dose of 62Gy/23Fx/5weeks as well as 5-Fu general chemotherapy could provide definite palliative benefit with tolerable acute radiation related toxicity.