Stereotactic body radiotherapy for unresected pancreatic cancer: A nationwide review
Stereotactic body radiotherapy for unresected pancreatic cancer: A nationwide review
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DOI：
10.1002/cncr.30856
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发表时间：
2017-11-01
期刊：
影响因子：
6.2
通讯作者：
Tseng, Jennifer F.
中科院分区：
文献类型：
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作者：
de Geus, Susanna W. L.;Eskander, Mariam F.;Tseng, Jennifer F.
背景常规放射治疗在胰腺癌治疗中的作用尚未阐明。在过去的十年中，立体定向体部放射治疗（SBRT）已成为胰腺癌护理的一种新的治疗选择。本研究评估了SBRT对未切除胰腺癌患者生存率的影响。方法查询了2004年至2012年期间接受非转移性胰腺癌化疗的未切除患者的国家癌症数据库。确定了4个治疗组：单独化疗、化疗联合外照射放疗（EBRT）、化疗联合调强放疗（IMRT）和化疗联合SBRT。建立预测接受SBRT几率的倾向评分模型，以控制潜在的选择偏倚，并通过倾向评分匹配患者。生存分析采用Kaplan-Meier法，共14,331例患者符合纳入标准。5464例患者（38.1%）接受了单独化疗; 6418例（44.8%）、322例（2.3%）和2127例（14.8%）分别接受化疗沿着EBRT、IMRT和SBRT。接受化疗、EBRT、IMRT和SBRT治疗的患者匹配前未校正的中位生存期分别为9.9、10.9、12.0和13.9个月。在单独的匹配分析中，SBRT仍然上级单独化疗（对数秩P < .0001）和EBRT（对数秩P = .0180）。匹配后，接受IMRT和SBRT的患者之间的生存率没有差异（对数秩P = 0.0492）。CONCLUSIONSSBRT与化疗单独或与传统EBRT相结合的显着更好的结果。这些结果支持SBRT是未切除胰腺癌患者的一种有前途的治疗方法。癌症2017;123：4158-4167。(c)2017年美国癌症协会。这项人群水平的分析表明，立体定向体部放疗与单独化疗或与传统外射束放疗联合治疗相比，结局明显更好。这些结果强调，立体定向体部放射治疗是一种有前途的治疗方法，为患者的未切除胰腺癌。
BACKGROUNDThe role of conventional radiotherapy in the management of pancreatic cancer has yet to be elucidated. Over the past decade, stereotactic body radiotherapy (SBRT) has emerged as a novel therapeutic option in pancreatic cancer care. This study evaluated the survival impact of SBRT on patients with unresected pancreatic cancer.METHODSThe National Cancer Data Base was queried for unresected patients who received chemotherapy for nonmetastatic pancreatic adenocarcinoma between 2004 and 2012. Four treatment groups were identified: chemotherapy alone, chemotherapy combined with external-beam radiotherapy (EBRT), chemotherapy combined with intensity-modulated radiotherapy (IMRT), and chemotherapy combined with SBRT. Propensity score models predicting the odds of receiving SBRT were created to control for potential selection bias, and patients were matched by propensity scores. The survival analysis was performed with the Kaplan-Meier method.RESULTSA total of 14,331 patients met the inclusion criteria. Chemotherapy alone was delivered to 5464 patients (38.1%); 6418 (44.8%), 322 (2.3%), and 2127 (14.8%) received chemotherapy along with EBRT, IMRT, and SBRT, respectively. The unadjusted median survival before matching was 9.9, 10.9, 12.0, and 13.9 months for patients treated with chemotherapy, EBRT, IMRT, and SBRT, respectively. In separate matched analyses, SBRT remained superior to chemotherapy alone (log-rank P < .0001) and EBRT (log-rank P = .0180). After matching, survival did not differ between patients receiving IMRT and patients receiving SBRT (log-rank P = .0492).CONCLUSIONSSBRT is associated with a significantly better outcome than chemotherapy alone or in conjunction with traditional EBRT. These results support the idea that SBRT is a promising treatment approach for patients with unresected pancreatic cancer. Cancer 2017;123:4158-4167. (c) 2017 American Cancer Society.This population-level analysis demonstrates that stereotactic body radiotherapy is associated with a significantly better outcome than chemotherapy alone or in conjunction with traditional external-beam radiotherapy. These results emphasize that stereotactic body radiotherapy is a promising treatment approach for patients with unresected pancreatic cancer.