Stereotactic body radiotherapy in the treatment of pancreatic adenocarcinoma in elderly patients.
Stereotactic body radiotherapy in the treatment of pancreatic adenocarcinoma in elderly patients.
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DOI：
10.1186/1748-717x-8-240
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发表时间：
2013-10-16
期刊：
影响因子：
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通讯作者：
Burton SA
中科院分区：
文献类型：
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作者：
Kim CH;Ling DC;Wegner RE;Flickinger JC;Heron DE;Zeh H;Moser AJ;Burton SA
老年人胰腺癌的治疗常常合并并发症，无法进行手术、化疗和/或常规外照射治疗(EBRT)。立体定向全身放射治疗(SBRT)因此引起了人们的兴趣。对2007年至2011年接受≥+/-化疗的26例80岁高龄胰腺癌患者进行了回顾性分析。27%的患者为I期，38%为II期，27%为III期，8%为IV期。患者最常接受24Gy1次或30~36Gy3次。采用Kaplan-Meier法评估总生存期(OS)、局部控制率(LC)、原因特异性生存期(CS)和无转移生存率(FFMD)。中位年龄86岁(80~91岁)，中位随访期11.6个月(3.5~24.6个月)。规划目标体量中值为214.8亿立方米(6.1-85.09)。中位OS为7.6个月，6/12个月OS率为65.4%/34.6%。中位LC为11.5个月，6个月和12个月精算LC率分别为60.1%和41.2%。LC没有独立的预测因素，但处方剂量大于20GY的LC有改善的趋势(p = 0.063)。中位数CS为6.3个月，6个月和12个月精算CS分别为53.8%和23.1%。中位数FFMD为8.4个月，6个月和12个月精算率分别为62.0%和41.4%。9名患者(47%)有局部失败，11名(58%)有远处转移，7名(37%)两者都有。未发生急性或晚期3+级毒性反应。明确的SBRT对于患有不能切除的疾病、有不能手术或拒绝手术的合并症的老年患者是可行、安全和有效的。
Treatment of pancreatic adenocarcinoma in the elderly is often complicated by comorbidities that preclude surgery, chemotherapy and/or conventional external beam radiation therapy (EBRT). Stereotactic body radiotherapy (SBRT) has thus garnered interest in this setting. A retrospective review of 26 patients of age ≥ 80 with pancreatic adenocarcinoma treated with definitive SBRT+/-chemotherapy from 2007–2011 was performed. Twenty-seven percent of patients were stage I, 38% were stage II, 27% were stage III and 8% were stage IV. Patients most commonly received 24 Gy/1 fraction or 30-36 Gy/3 fractions. Kaplan-Meier was used to estimate overall survival (OS), local control (LC), cause specific survival (CSS) and freedom-from-metastatic disease (FFMD). The median age was 86 (range 80–91), and median follow-up was 11.6 months (3.5-24.6). The median planning target volume was 21.48 cm3 (6.1-85.09). Median OS was 7.6 months with 6/12 month OS rates of 65.4%/34.6%, respectively. Median LC was 11.5 months, 6-month and 12-month actuarial LC rates were 60.1% and 41.2%, respectively. There were no independent predictors for LC, but there was a trend for improved LC with prescription dose greater than 20 Gy (p = 0.063). Median CSS was 6.3 months, and 6-month and 12-month actuarial CSS were 53.8% and 23.1%, respectively. Median FFMD was 8.4 months, and 6-month and 12-month actuarial rates were 62.0% and 41.4%, respectively. Nine patients (47%) had local failures, 11 (58%) had distant metastasis, and 7 (37%) had both. There were no acute or late grade 3+ toxicities. Definitive SBRT is feasible, safe and effective in elderly patients who have unresectable disease, have comorbidities precluding surgery or decline surgery.