Local Control and Survival After Induction Chemotherapy and Ablative Radiation Versus Resection for Pancreatic Ductal Adenocarcinoma With Vascular Involvement.
Local Control and Survival After Induction Chemotherapy and Ablative Radiation Versus Resection for Pancreatic Ductal Adenocarcinoma With Vascular Involvement.
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DOI：
10.1097/sla.0000000000005080
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发表时间：
2021-12-01
影响因子：
9
通讯作者：
Wei AC
中科院分区：
文献类型：
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作者：
Jolissaint JS;Reyngold M;Bassmann J;Seier KP;Gönen M;Varghese AM;Yu KH;Park W;O'Reilly EM;Balachandran VP;D'Angelica MI;Drebin JA;Kingham TP;Soares KC;Jarnagin WR;Crane CH;Wei AC
我们试图比较局部胰腺癌（PDAC）患者接受消融剂量放疗（A-RT）与切除术治疗的总生存率（OS）和疾病控制情况。PDAC的局部治疗包括可能的切除或姑息性RT。A-RT可能提供持久的肿瘤控制和鼓励生存。这是一项对接受诱导化疗后接受A-RT（≥ 98戈伊生物有效剂量（BED），15-25次，3-4.5戈伊/次）或胰腺切除术治疗的PDAC患者进行的单机构回顾性分析。104例患者接受A-RT（49.8%），105例（50.2%）接受切除术。接受A-RT的患者在诱导化疗后的中位肿瘤大小较大[3.2 cm（不可检测-10.9）vs. 2.6 cm（未检测到-10.7），P<0.001]，更可能有腹腔或肝动脉包裹（48.1% vs. 11.4%，P<0.001）或上级肠系膜动脉包绕（43.3% vs. 9.5%，P<0.001）;但SMV/PV受累程度无差异（P=0.123）。A-RT和切除术在18个月时的局部复发/进展方面没有差异;累积发生率分别为16%（95% CI 10%−24%）和21%（95% CI 14%−30%）（P=0.252）。然而，接受A-RT的患者的18个月远处复发/进展累积发生率高出19%（58% [95% CI 48%-67%] vs. 30% [95% CI 30%-49%]，P=0.004）。A-RT患者完成化疗后的中位OS为20.1个月（95% C. I. 16.4-23.1个月）与32.9个月（95% C.I. 29.7-42.3个月）手术切除组与手术切除组比较差异有显著性（P<0.001）。消融放射是PDAC的一种有前途的新治疗选择，提供与切除术相关的局部疾病控制，并提高生存率。这是一项对接受诱导化疗后行消融剂量放疗（A-RT）或胰腺切除术的胰腺导管腺癌（PDAC）患者进行的回顾性分析。局部疾病控制相当，局部复发/进展的累积发生率分别为16%和21%，A-RT和切除术（P =0.252）。A-RT患者完成化疗后的中位OS为20.1个月（95% C. I. 16.4-23.1个月）与32.9个月（95% C.I. 29.7-42.3个月）手术切除组与手术切除组比较差异有显著性（P<0.001）。
We sought to compare overall survival (OS) and disease control for patients with localized pancreatic adenocarcinoma (PDAC) treated with ablative dose radiotherapy (A-RT) vs. resection. Locoregional treatment for PDAC includes resection when possible or palliative RT. A-RT may offer durable tumor control and encouraging survival. This was a single-institution retrospective analysis of patients with PDAC treated with induction chemotherapy followed by A-RT (≥ 98Gy biologically effective dose (BED) using 15–25 fractions in 3–4.5 Gy/fraction) or pancreatectomy. One hundred and four patients received A-RT (49.8%) and 105 (50.2%) underwent resection. Patients receiving A-RT had larger median tumor size after induction chemotherapy [3.2 cm (undetectable-10.9) vs. 2.6 cm (undetectable-10.7), P<0.001], and were more likely to have celiac or hepatic artery encasement (48.1% vs. 11.4%, P<0.001), or superior mesenteric artery encasement (43.3% vs. 9.5%, P<0.001); however, there was no difference in the degree of SMV/PV involvement (P=0.123). There was no difference in locoregional recurrence/progression at 18-months between A-RT and resection; cumulative incidence was 16% (95% CI 10%−24%) vs. 21% (95% CI 14%−30%), respectively (P=0.252). However, patients receiving A-RT had a 19% higher 18-month cumulative incidence of distant recurrence/progression (58% [95% CI 48%−67%] vs. 30% [95% CI 30%−49%], P=0.004). Median OS from completion of chemotherapy was 20.1 months for A-RT patients (95% C.I. 16.4–23.1 mo.) vs. 32.9 months (95% C.I. 29.7–42.3 mo.) for resected patients (P<0.001). Ablative radiation is a promising new treatment option for PDAC, offering locoregional disease control similar to that associated with resection and encouraging survival. This was a retrospective analysis of patients with pancreatic ductal adenocarcinoma (PDAC) treated with induction chemotherapy followed by ablative dose radiotherapy (A-RT) or pancreatectomy. Locoregional disease control was comparable, with a cumulative incidence of locoregional recurrence/progression of 16% vs. 21%, for A-RT and resection, respectively (P =0.252). Median OS from completion of chemotherapy was 20.1 months for A-RT patients (95% C.I. 16.4–23.1 mo.) vs. 32.9 months (95% C.I. 29.7–42.3 mo.) for resected patients (P<0.001).