低分割三维适形调强放疗治疗局部进展期胰腺癌的临床观察

目的 探讨氟尿嘧啶（5-FU）联合低分割影像引导的三维适形调强放疗治疗局部进展期胰腺癌的疗效和毒副反应。方法 收集2011年6月至2014年12月间收治的37例经病理组织学证实的不可切除局部进展期胰腺癌，均采用CT引导下三维适形调强放疗技术，放疗采用大分割3.0～3.1 Gy／次，16次，DT 48～49.6 Gy；同步化疗方案：5-FU 350 mg／m2，每日1次，一周5次，与放疗同步进行。观察疗效和毒副反应，并随访生存。结果 所有患者均完成放疗。同步放化疗获CR 5例，PR 14例，SD 14例，PD 4例，有效率为51.4％（19/37）；临床受益反应有效者21例，临床受益率为56.8％（21/37）。同步放化疗期间发生3级以上骨髓抑制7例，严重胆道梗阻1例，胃十二指肠溃疡2例。37例患者1、2年无远处转移生存率分别为36.0％、4.8％；1、2年生存率分别为51.3％、11.6％。至随访截止日期，13例患者出现局部复发，26例患者出现远处转移。结论 氟尿嘧啶联合低分割影像引导的适形调强放疗治疗局部进展期胰腺癌疗效较好，毒副反应可耐受。

Observation of hypofractionated three dimensional conformal intensity modulated radiation therapy for lo-cally advanced pancreatic carcinoma

Objective To explore the efficacy and side effects of 5-filuorouracil combined hypofractionated image-guided three dimensional conformal intensity modulated radiation therapy （3D-IMRT） for locally advanced pancreatic carcinoma. MethodsFrom June 2011 to December 2014， a total of 37 patients with locally advanced pancreatic carcinoma proved by histopathology were enrolled in this study. Patients were treated by image-guided 3D-IMRT （radiation dose was 48-49.6 Gy in 16 fractions） and 5-filuorouracil（a dose of 350 mg／m2，d1-d5，weekly）. The treatment efficacy and side effects was observed and all patients were followed-up. Results All patients completed 3D-IMRT. There was 5 patients got CR, 14 got PR, 14 got SD and 4 got SD. The response rate was 51.4％（19/37）， and clinical benefit response rate was 56.8％（21/37）. During the treatment， grade 3 hematologic toxicities occurred in 7 patients， serious biliary obstruction occurred in 1 patient， gastroduodenal ulcer occurred in 2 patients. The 1- and 2-year distance metastasis free survival were 36.0％ and 4.8％. The 1- and 2-year overall survival rates were 51.3％ and 11.6％. At the end date of the follow-up， 13 patients got local recurrence， 26 patients had distant metastasis. Conclusion 5-filuorouracil combined hypofractionated image-guided 3D-IMRT is effective and well-tolerated for patients with locally advanced pancreatic carcinoma.