Stereotactic Body Radiation Therapy (SBRT) Combined With Chemotherapy for Unresected Pancreatic Adenocarcinoma.
Stereotactic Body Radiation Therapy (SBRT) Combined With Chemotherapy for Unresected Pancreatic Adenocarcinoma.
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DOI：
10.1097/coc.0000000000000118
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发表时间：
2017-04
期刊：
影响因子：
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通讯作者：
Unger K
中科院分区：
文献类型：
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作者：
Gurka MK;Kim C;He AR;Charabaty A;Haddad N;Turocy J;Johnson L;Jackson P;Weiner LM;Marshall JL;Collins SP;Pishvaian MJ;Unger K
放射治疗在不能切除的胰腺癌治疗中的作用是有争议的。同步放化疗的一个问题与化疗的时机有关。与传统放射治疗相比，立体定向全身放射治疗(SBRT)在较短的时间内提供高剂量，从而最大限度地减少对化疗的干扰。在这里，我们报告了不能手术的胰腺癌患者接受SBRT和化疗的结果。从2008年1月至2012年12月，在我所接受SBRT和化疗的38例局部晚期、边缘可切除和医学上不能手术的胰腺癌患者纳入了这项回顾分析。治疗分5次进行，每次5或6Gy5天。使用第3版不良事件通用术语标准对毒副作用进行评分。使用Kaplan-Meier方法计算存活率。中位年龄为70岁(45~90岁)。东部合作肿瘤组的评分从0到3。34名患者同时接受化疗。4名患者接受了序贯化疗。中位总生存期为14.3个月，中位无进展生存期为9.2个月。放疗后总生存期为12.3个月，无进展生存期为6.8个月。总体局控率为79%。急性毒性最小。晚期SBRT相关的严重毒副反应包括1例3级胃出口梗阻，1例4级胆管狭窄，1例5级胃出血。SBRT联合化疗治疗不能切除的胰腺癌是一种方便、可行、耐受性好的治疗方法。SBRT联合化疗的疗效优于化疗和常规放射治疗。
The role of radiation therapy in the management of unresectable pancreatic cancer is controversial. One concern about concurrent chemoradiation relates to the timing of chemotherapy. In contrast to conventional radiation therapy, stereotactic body radiation therapy (SBRT) delivers high doses in a shorter duration resulting in minimal disruption in chemotherapy. Here, we report our results of patients treated with SBRT and chemotherapy for inoperable pancreatic cancer. Thirty-eight patients treated with SBRT and chemotherapy for locally advanced, borderline resectable, and medically inoperable pancreatic cancer at our institution from January 2008 to December 2012 were included in this retrospective analysis. Treatment was delivered in 5 fractions of 5 or 6 Gy per fraction over 5 days. Toxicities were scored using the Common Terminology Criteria for Adverse Events version 3. Survival was calculated using the Kaplan-Meier method. The median age was 70 years (range, 45 to 90 y). Eastern Cooperative Oncology Group performance status ranged from 0 to 3. Thirty-four patients received concurrent chemotherapy. Four patients received sequential chemotherapy. Median overall survival was 14.3 months and median progression-free survival was 9.2 months from diagnosis. From radiation, overall survival and progression-free survival were 12.3 and 6.8 months, respectively. The overall local control rate was 79%. Acute toxicity was minimal. Severe late SBRT-related toxicities included 1 grade 3 gastric outlet obstruction, 1 grade 4 biliary stricture, and 1 grade 5 gastric hemorrhage. SBRT combined with chemotherapy for unresectable pancreatic cancer is convenient, feasible, and generally well tolerated. Outcomes of SBRT combined with chemotherapy compare favorably to results obtained with chemotherapy and conventional radiation therapy.