A Prospective Study of Intensity-modified Radiation Therapy in Comparison with Conventional 3D-RT for BR Pancreatic Cancer Patients with Arterial Involvement
A Prospective Study of Intensity-modified Radiation Therapy in Comparison with Conventional 3D-RT for BR Pancreatic Cancer Patients with Arterial Involvement
复制标题
DOI：
10.21873/anticanres.12172
复制
发表时间：
2017-12-01
影响因子：
2
通讯作者：
Uemoto, Shinji
中科院分区：
文献类型：
--
作者：
Masui, Toshihiko;Takaori, Kyoichi;Uemoto, Shinji
背景/目的：调强放射治疗(IMRT)是一种能够在减少对周围组织损害的情况下进行精确照射的放射治疗形式。在这里，我们分析了采用调强放疗作为新辅助治疗的边缘可切除胰腺癌(BRPC)和动脉基台(BR-A)患者，并与常规放疗患者进行了比较，以阐明调强放疗作为新辅助治疗的优势。患者和方法：将2012年1月至2015年12月收治的30例BR-A患者分为两组：术前常规3D-RT组12例(RT组)，术前调强放射治疗18例(IMRT组)。我们分析了安全性、肿瘤切除率、肿瘤的组织学分类和总存活率。结果：调强放疗组R0率为84%，放疗组为83%。根据Evans分级，调强放疗组局部控制率(1级0%；2a级25%；2b级41.6%；3级17%；4级8%)高于单纯放疗组(1级17%；2a级50%；2b级17%；4级0%)。作为辅助治疗的S1治疗的累积剂量在放疗组(18.3%)比调强放疗组(57.1%)小得多(p=0.047)，并且有较好的后续总生存率(32个月vs.13.8个月，p=0.0273)。结论：调强放疗组的控制率优于单纯放疗组。新辅助调强放疗具有辅助化疗完成率高、营养状况好、术后总生存率(OS)高等优点。
Background/Aim: Intensity-modulated radiation therapy (IMRT) is a form of radiation therapy that allows accurate irradiation with reduced damage to surrounding tissues. Here, we analyzed borderline-resectable pancreatic cancer (BRPC) with arterial abutment (BR-A) patients with IMRT as neoadjuvant therapy and performed comparisons with patients with conventional RT to clarify the advantages of IMRT as a neoadjuvant therapy. Patients and Methods: Thirty BR-A patients treated at our hospital between January 2012 and December 2015 were divided into two groups: 12 patients underwent conventional 3D-RT before resection (RT group); and 18 patients underwent IMRT before resection (IMRT group). We analyzed safety, tumor resection rate, histological classification of the tumor and overall survival. Results: The R0 rate was 84% for the IMRT group and 83% for the RT group. Local therapeutic effects as assessed by Evans classification showed a higher local control rate in the IMRT group (Grade: 1, 0%; 2a, 25%; 2b, 41.6%; 3, 17%; 4, 8%) than in the RT group (Grade: 1, 17%; 2a, 50%; 2b, 17%; 3, 17%; 4, 0%). The cumulative dose of S1 treatment as adjuvant therapy was much smaller in the RT group (18.3%) compared to that in the IMRT group (57.1%, p= 0.047), and with better subsequent overall survival rate (MST 32 months vs. 13.8 months, p= 0.0273). Conclusion: The IMRT group showed a better control rate than the RT group. The neoadjuvant IMRT has advantages of higher completion rate of adjuvant chemotherapy with better nutritional status and better subsequent overall survival rate (OS).