射波刀治疗局部进展期及合并远处转移胰腺癌的效果分析

目的评价射波刀治疗局部进展期及合并远处转移胰腺癌的有效性和安全性。方法选取2012年1月-2015年4月在解放军总医院第五医学中心接受射波刀治疗的胰腺癌患者32例(9例联合动脉灌注化疗治疗),其中局部进展期18例,合并远处转移14例(肝转移12例,其中2例合并肺转移;骨转移2例)。治疗后每2个月进行1次影像学评价,采用实体瘤的疗效评价标准(RECIST)对局部缓解率进行分级,采用CT为基础的影像学检查评价肿瘤有无进展,应用常见不良反应事件标准(CTCAE3. 0)评价不良反应。Kaplan-Meier法计算总生存期和局部无进展生存期,log-rank检验分析不同分组患者之间总生存期差异。结果 32例患者中病变位于胰头21例、胰体尾11例;病理为腺癌30例,其他2例; TNM分期:T3 25例,T4 7例; N0 23例,N1 9例; M0 18例,M1 14例。9例射波刀联合动脉灌注化疗治疗中5例胃十二指肠动脉、1例肠系膜上动脉、3例脾动脉。32例患者中4例(12. 50%)完全缓解,18例(56. 25%)为部分缓解,6例(18. 75%)为疾病稳定,4例(12. 50%)出现疾病进展。32例患者的1、2年总生存率分别为43. 7%、31. 3%,局部无进展生存率分别为87. 5%、84. 4%,中位总生存期为8. 5个月(1~39个月)。18例局部进展期患者中位总生存期为21个月(1~36个月),14例合并远处转移患者中位总生存期为5. 5个月(1~39个月),差异无统计学意义(P=0. 303); 9例联合动脉灌注化疗患者的中位总生存期为17个月(1~39个月),23例单放疗患者总生存期为8个月(1~36个月),差异无统计学意义(P=0. 756)。1~2级急性和晚期胃肠道反应发生率为78%,主要为恶心、呕吐、腹痛和腹泻。1例患者出现3级晚期胃肠道反应,表现为十二指肠溃疡出血,行急诊介入弹簧圈堵塞靶血管后出血停止。20例腹部或腰背部疼痛患者中12例在治疗完成2周后疼痛症状明显减轻。结论采用射波刀治疗局部进展期及合并远处转移胰腺癌可获得很好疗效,且并发症少。

Clinical effect of Cyber Knife radiosurgery in locally advanced pancreatic cancer or pancreatic cancer with distant metastasis

Objective To investigate the clinical effect of CyberKnife radiosurgery in locally advanced pancreatic cancer or pancreatic cancer with distant metastasis. Methods A retrospective analysis was performed for the clinical data of 32 patients with pancreatic cancer who were treated with CyberKnife radiosurgery in The Fifth Medical Center of Chinese PLA General Hospital from January 2012 to April 2015,among whom 9 patients received arterial infusion chemotherapy in addition. Among these 32 patients,18 had locally advanced pancreatic cancer and 14 had pancreatic cancer with distant metastasis( 12 had liver metastasis,2 had lung metastasis,and 2 had bone metastasis). Radiological evaluation was performed every two months after treatment; Response Evaluation Criteria in Solid Tumors( RECIST) was used to evaluate local remission rate; CT-based radiological examination was used to assess the presence or absence of tumor progression; Common Terminology Criteria for Adverse Events Version 3. 0( CTCAE3. 0) was used to analyze adverse events. The Kaplan-Meier method was used to calculate overall survival time and local progression-free survival,and the log-rank test was used for the comparison of overall survival time between groups. Results Of all 32 patients,21 had lesions in the head of the pancreas and 11 had lesions in the body and tail of the pancreas; according to pathology,30 had adenocarcinoma and 2 had other pathological types; according to TNM staging,25 had T3 and 7 had T4 pancreatic cancer,23 had N0 and 9 had N1 pancreatic cancer,18 had M0 and 14 had M1 pancreatic cancer. Among the 9 patients who were treated with CyberKnife combined with arterial infusion chemotherapy,5 received chemotherapy via the gastroduodenal artery,1 received chemotherapy via the superior mesenteric artery,and 3 received chemotherapy via the splenic artery. Of all 32 patients,4( 12. 50%) achieved complete remission,18( 56. 25%) achieved partial remission,6( 18. 75%) achieved a stable disease,and 4( 12. 50%) experienced disease progression. The1-and 2-year overall survival rates were 43. 7% and 31. 3%,respectively; the 1-and 2-year local progression-free survival rates were87. 5% and 84. 4%,respectively; the median overall survival time was 8. 5 months( range 1-39 months). The 18 patients with locally advanced pancreatic cancer had a median overall survival time of 21 months( range 1-36 months),and the 14 patients with pancreatic cancer with distant metastasis had a median overall survival time of 5. 5 months( range 1-39 months),and there was no significant difference between the two groups( P = 0. 303). The 9 patients who received arterial infusion chemotherapy in addition to CyberKnife had a median overall survival time of 17 months( range 1-39 months),and the 23 patients who received CyberKnife alone had a median overall survival time of 8 months( range 1-36 months),and there was no significant difference between the two groups( P =0. 756). The incidence rate of grade 1-2 acute and late gastrointestinal toxicity was 78%,with major symptoms of nausea,vomiting,abdominal pain,and diarrhea. One patient experienced grade 3 late gastrointestinal toxicity manifesting as duodenal ulcer bleeding,and the bleeding was stopped by emergency intervention with a coil to block the target blood vessel. Among the 20 patients with abdominal pain or lower back pain,12 achieved marked alleviation of pain symptoms at 2 weeks after treatment. Conclusion CyberKnife radiosurgery has a good clinical effect in the treatment of locally advanced pancreatic cancer or pancreatic cancer with distant metastasis and has few complications.