高强度聚焦超声与伽玛刀治疗晚期胰腺癌的对比观察*

目的：本研究主要对比观察高强度聚焦超声（HIFU）与伽玛刀治疗伴有癌痛的晚期胰腺癌疗效和不良反应。方法：回顾性分析武警上海总队医院2006年3 月至2008年10月收治晚期胰腺癌患者80例，其中26例（A 组）为HIFU治疗，54例（B 组）为伽玛刀治疗。对比评价两组的近期有效率（CR+PR）、平均生存期、临床受益率（CBR ）及不良反应。CBR 评价标准：疼痛程度减轻≥50% ，持续4 周以上；止痛药用量减少≥50% ，持续4 周以上；Karnofsky 评分增加≥20% ，持续4 周以上，体重增加7% 。结果：两组的平均生存期分别为（5.6 ± 4.1）个月及（5.4 ± 3.6）个月。A 组近期有效率26.9% ，B 组24.1% ，两组无显著性差异。A 组CBR 为84.6% ，B 组为57.4% 。两组比较差异有统计学意义（P=0.022）。 主要不良反应为：骨髓抑制，恶心，呕吐。A 组的不良反应明显小于B 组（P=0.040）。 结论：高强度聚焦超声与伽玛刀均是治疗晚期胰腺癌的安全、有效的治疗方法。HIFU与伽玛刀治疗的近期疗效与远期疗效相似，但在改善患者疼痛、体力状态等方面优于伽玛刀。在两者的不良反应上，HIFU治疗的骨髓抑制、消化道反应等方面均明显低于伽玛刀。提示HIFU可以应用于一般状况更差的患者。

Retrospective Study of High Intensity Focused Ultrasound Compared with Gamma Knife Radiotherapy in Treatment of Advanced Pancreatic Carcinoma

Objective:To compare the clinical effects and adverse reactions of high intensity focused ultrasound (HIFU) and gamma knife radiotherapy for treatment of advanced pancreatic carcinoma. Methods:Eighty patients with advanced pancreatic carcinoma were divided into 2 groups. Group A ( n=26) patients underwent HIFU. In Group B ( n=54), patients re -ceived gamma knife radiotherapy. The treatment effects including the rates of local control, mean survival time, clinical ben-efit response (CBR) and the frequency of complication in the 2 groups were compared. CBR was defined as a≥50% re-duction in pain intensity, ≥50% reduction in daily analgesic consumption, or≥20point improvement in KPS that lasted for ≥4 consecutive weeks. The tumor response rate was evaluated by RECIST. Results:Average survival period was 5.6 ± 4.1 and 5.4 ± 3.6 months, respectively. The rates of local control in the2 groups were 26.9% and 24.1%, respectively. No sig-nificant statistical differences were shown (P=0.962 ). The CBR was 84.6% in Group A, and 57.4% in Group B, which showed a significant difference between the 2 groups (P= 0.022 ). The major adverse reactions were: bone marrow suppres -sion, nausea, vomiting. The rates of complication in group A were distinctly lower than those in Group B (P=0.040 ). Conclusion: HIFU and gamma knife radiotherapy were both noninvasive, safe, and effective palliative therapy methods for ad-vanced pancreatic cancer. The overall response rates and average survival periods were similar. But HIFU therapy was su-perior to gamma knife radiotherapy in pain alleviation. As well, there was less injury, less bone marrow depression and less nausea and vomiting in HIFU therapy group. HIFU was adaptable for the patients who were in bad general condition, who couldn ’t tolerate the gamma knife radiotherapy.