Focal Radiation Therapy Dose Escalation Improves Overall Survival in Locally Advanced Pancreatic Cancer Patients Receiving Induction Chemotherapy and Consolidative Chemoradiation.
Focal Radiation Therapy Dose Escalation Improves Overall Survival in Locally Advanced Pancreatic Cancer Patients Receiving Induction Chemotherapy and Consolidative Chemoradiation.
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DOI：
10.1016/j.ijrobp.2015.12.003
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发表时间：
2016-03-15
期刊：
影响因子：
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通讯作者：
Crane CH
中科院分区：
文献类型：
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作者：
Krishnan S;Chadha AS;Suh Y;Chen HC;Rao A;Das P;Minsky BD;Mahmood U;Delclos ME;Sawakuchi GO;Beddar S;Katz MH;Fleming JB;Javle MM;Varadhachary GR;Wolff RA;Crane CH
回顾局部晚期胰腺癌（LAPC）患者接受剂量递增调强放疗（IMRT）治疗的结局。在2006年至2014年期间，共有200例LAPC患者接受了诱导化疗，然后接受了放化疗。其中，选择47例（24%）肿瘤距离管腔器官>1 cm的患者进行剂量递增调强放疗（生物有效剂量[BED] >70戈伊），使用同时整合增强技术、吸气屏气和计算机断层扫描图像引导。针对大体肿瘤覆盖率和管腔器官保留率优化分级。使用显微剂量的同时整合加强治疗大体肿瘤体积周围的2- 5-mm边缘。总生存期（OS）、无复发生存期（RFS）、局部-区域和远处RFS以及至局部-区域和远处复发的时间（从放化疗开始计算）是关注的结局。中位放射剂量为50.4戈伊（BED = 59.47戈伊），同时使用基于卡培他滨（86%）的方案。接受BED >70戈伊的患者具有较好的上级OS（17.8 vs 15.0个月，P = .03），在整个随访期间保持不变，2年时的估计OS率为36% vs 19%，3年时为31% vs 9%，沿着局部区域RFS改善（10.2 vs 6.2个月，P = 0.05）与接受BED ≤70戈伊的患者相比。大体肿瘤体积覆盖的程度似乎不影响结果。在高剂量组中未观察到额外毒性。在多变量分析中，较高剂量（BED）是OS改善的唯一预测因素。LAPC患者诱导化疗后巩固放化疗期间的放射剂量递增可改善OS和局部区域RFS。
To review outcomes of locally advanced pancreatic cancer (LAPC) patients treated with dose-escalated intensity modulated radiation therapy (IMRT) with curative intent. A total of 200 patients with LAPC were treated with induction chemotherapy followed by chemoradiation between 2006 and 2014. Of these, 47 (24%) having tumors >1 cm from the luminal organs were selected for dose-escalated IMRT (biologically effective dose [BED] >70 Gy) using a simultaneous integrated boost technique, inspiration breath hold, and computed tomographic image guidance. Fractionation was optimized for coverage of gross tumor and luminal organ sparing. A 2- to 5-mm margin around the gross tumor volume was treated using a simultaneous integrated boost with a microscopic dose. Overall survival (OS), recurrence-free survival (RFS), local-regional and distant RFS, and time to local-regional and distant recurrence, calculated from start of chemoradiation, were the outcomes of interest. Median radiation dose was 50.4 Gy (BED = 59.47 Gy) with a concurrent capecitabine-based (86%) regimen. Patients who received BED >70 Gy had a superior OS (17.8 vs 15.0 months, P = .03), which was preserved throughout the follow-up period, with estimated OS rates at 2 years of 36% versus 19% and at 3 years of 31% versus 9% along with improved local-regional RFS (10.2 vs 6.2 months, P = .05) as compared with those receiving BED ≤70 Gy. Degree of gross tumor volume coverage did not seem to affect outcomes. No additional toxicity was observed in the high-dose group. Higher dose (BED) was the only predictor of improved OS on multivariate analysis. Radiation dose escalation during consolidative chemoradiation therapy after induction chemotherapy for LAPC patients improves OS and local-regional RFS.