强度聚焦超声治疗老年胰腺癌的疗效观察

目的观察高强度聚焦超声（high intensity focused ultrasound，HIFU）对老年中晚期胰腺癌患者的治疗作用。方法52例老年中晚期胰腺癌患者，年龄60～83岁，平均年龄（70．8±5．1）岁，按随机表法分为HIFU＋化疗组和单纯化疗组。HIFU＋化疗组应用HIFU及吉西他滨静脉滴注；对照组单纯化疗组给予吉两他滨静脉滴注。观察治疗后2个月肿瘤体积变化、患者疼痛缓解程度和不良反应发生率，记录治疗后3个月和6个月的生存率。结果HIFU＋化疗组根据实体肿瘤疗效的客观评判标准（肿瘤消长），完全缓解率（CR）＋部分缓解率（PR）为55．1％，高于单纯化疗组的26．1％（P=0．037）；HIFU＋化疗组疼痛缓解阳性改善率为69．O％，高于单纯化疗组的21．7％（P=0．001）；两组并发症无统计学差异；HIFU＋化疗组患者的3个月生存率为100％（29／29），单纯化疗组为91．3％（21／23），两组无统计学差异（P=0．109）；HIFU＋化疗组6个月生存率为72．4％（21／29），较单纯化疗组的30．4％（7／23）增加（P=0．025）。结论HIFU作为一种绿色的治疗手段，联合吉西他滨化疗可以更有效地控制晚期胰腺癌的肿瘤生长，缓解患者疼痛．延长患者生存期，且无明显不良反应．是一种有效、安全的治疗方法。

Clinical outcome assessment of high intensity focused ultrasound ablation for pancreatic cancer in elderly patients

Objective To evaluate the safety and efficacy of high intensity focused ultrasound （HIFU） ablation for advanced pancreatic cancer in elderly patients. Methods Fifty-two elderly patients with advanced pancreatic cancer were randomly divided into two groups： HIFU group, receiving HIFU ablation combined with intravenous gemcitabine, and control group, treated with gemcitabine only. Pain score, tumor volume, and serum level of CA19-9 were recorded before and two month after treatment. Adverse reactions in 2 months after treatment and the survival rates of 3 months and 6 months were also recorded. The outcomes were compared between two groups. Results The total effective rate of tumor volume shrinkage in HIFU group was 55.1%, compared to 26.1% in control group （P=0.037）. The pain relief rate in HIFU group was 69.0%, while 21.7% in control group （P=0.001）. The incidence of adverse reactions in two groups had no significant difference. The 3-month survival rate in HIFU group was 100.0%, which had no significant difference with that in control group （91.3%, P=0.109）. The 6-month survival rate in HIFU group was 72.4%, which was significantly higher than that in the control group （30.4%, P=0.025）. Conclusion HIFU ablation, in combination with intravenous gemcitabine chemotherapy, is an effective and safe treatment for advanced pancreatic cancer in elderly patients, which can reduce tumor growth, alleviate abdominal pain and prolong survival period, with limited adverse reactions.