A phase II trial of neoadjuvant chemoradiotherapy with intensity-modulated radiotherapy combined with gemcitabine and S-1 for borderline-resectable pancreatic cancer with arterial involvement
A phase II trial of neoadjuvant chemoradiotherapy with intensity-modulated radiotherapy combined with gemcitabine and S-1 for borderline-resectable pancreatic cancer with arterial involvement
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DOI：
10.1007/s00280-017-3288-7
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发表时间：
2017-05-01
影响因子：
3
通讯作者：
Tsuchida, Akihiko
中科院分区：
文献类型：
--
作者：
Nagakawa, Yuichi;Hosokawa, Yuichi;Tsuchida, Akihiko
使用调强放射治疗（IMRT）的放化疗有望提供一种强有力的替代传统化疗的低发生率的不良事件。本研究评价调强放疗联合吉西他滨和替吉奥作为新辅助放化疗（NACRT）治疗动脉受累的边缘可切除胰腺癌（BR-A）的疗效。2012年2月至2015年9月期间，共有27例BR-A患者入组本研究。调强放疗剂量为50.4戈伊，分28次进行，同时吉西他滨剂量为600 mg/m2，S-1剂量为60 mg。只有1例患者（3.5%）发生了3级或更高的胃肠道不良事件。19例患者（70.3%）接受了切除术，18例患者（94.7%）实现了R 0切除。13例（68.4%）患者在切除术后的初始复发部位发生远处转移。仅1例患者（7.7%）出现局部复发。中位总生存期为22.4个月，1年生存率为81.3%，吉西他滨与替吉奥同步调强放疗作为非调强放疗是可行的，胃肠道毒性低。IMRT可用作标准放疗，以提供更有效的NACRT和强效化疗药物。
Chemoradiotherapy using intensity-modulated radiotherapy (IMRT) is expected to provide a powerful alternative to conventional chemotherapy with a low incidence of adverse events. This study evaluated the efficacy of intensity modulated radiotherapy in combination with gemcitabine and S-1 as neoadjuvant chemoradiotherapy (NACRT) for borderline-resectable pancreatic cancer with arterial involvement (BR-A).A total of 27 patients with BR-A were enrolled in this study between February 2012 and September 2015. IMRT was administered at 50.4 Gy in 28 fractions with concurrent gemcitabine at a dose of 600 mg/m(2) and S-1 at a dose of 60 mg.Only one patient (3.5%) experienced gastrointestinal adverse events at grade 3 or higher. Nineteen patients (70.3%) underwent resection, and R0 resection was achieved in 18 patients (94.7%). Thirteen patients (68.4%) developed distant metastasis at the initial site of recurrence after resection. Local recurrence developed in only one of these patients (7.7%). The median overall survival and 1-year survival rates were 22.4 months and 81.3%, respectively.Concurrent IMRT with gemcitabine and S-1 for patients is feasible as NACRT for BR-A with low gastrointestinal toxicity. IMRT can be employed as a standard radiotherapy to provide more effective NACRT with powerful chemotherapy drugs.