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目的回顾性分析局部晚期胰腺癌患者接受直线加速器X射线常规三维适形放射治疗(简称放疗)(3D-CRT组)与常规适形放疗加γ射线体部立体定向放疗加量治疗(SBRT加量组)之间的疗效差异。方法 40例局部晚期胰腺癌患者,其中男性22例,女性18例;年龄46～83岁,中位年龄72岁。3D-CRT组28例,SBRT加量组12例。ⅡA期(T3N0)6例,ⅡB(T1-3N1)5例,Ⅲ(T4N0-1)29例。单纯3D-CRT组计划总剂量46～50 Gy。SBRT加量组的常规适形放疗剂量计划为40 Gy(20次),然后采用SBRT追加加量16Gy(8次)。结果中位随访时间27个月(随访时间3～44个月),全组适形放疗中位肿瘤靶体积(GTV)为75.3 mL(GTV为17.5～191.7 mL),中位CTV为349.7 mL(CTV为114.4～727.9 mL)。SBRT加量CT定位时中位GTV为47.5mL(GTV为11.7～96.9mL)。3D-CRT组中位照射剂量46Gy(照射剂量18～50Gy),SBRT组适形放疗中位照射剂量40 Gy(照射剂量40～46 Gy),γ射线立体定向放疗加量中位照射剂量16 Gy(照射剂量14～20 Gy)。全组中位生存时间8.4个月(生存时间1.4～35.1个月),3D-CRT组与SBRT组的中位生存时间分别为8.2个月(生存时间1.4～21.2个月)、17.7个月(生存时间2.9～35.1个月),P>0.05。两组治疗相关急性和后期副反应差异无统计学意义。结论对于局部晚期胰腺癌患者,适形放疗加γ射线立体定向放疗加量耐受性好,有提高生存期的趋势。能否真正地提高生存率,有待进一步扩大样本研究。
Objective To retrospectively analyze the effect of conventional three-dimensional conformal radiotherapy (3D-CRT) combined with conventional conformal radiotherapy plus gamma-ray stereotactic radiotherapy on patients with locally advanced pancreatic cancer (SBRT plus dose Group) the difference between the efficacy. Methods Forty patients with locally advanced pancreatic cancer, including 22 males and 18 females, aged 46-83 years with a median age of 72 years. 28 cases in 3D-CRT group and 12 cases in SBRT plus dose group. 6 cases of stage Ⅱ A (T3N0), 5 cases of ⅡB (T1-3N1) and 29 cases of Ⅲ (T4N0-1). Simple 3D-CRT group plans a total dose of 46 ~ 50 Gy. Conventional radiotherapy dosimetry for the SBRT plus dose group was planned to be 40 Gy (20 times) followed by an additional dose of 16 Gy (8 times) with SBRT. Results The median follow-up time was 27 months (range 3 to 44 months). The median tumor target volume (GTV) was 75.3 mL (GTV 17.5-191.7 mL) and the median CTV was 349.7 mL CTV 114.4 ~ 727.9 mL). The median GTV for SBRT plus CT positioning was 47.5 mL (GTV 11.7 to 96.9 mL). In the 3D-CRT group, the median dose of irradiation was 46 Gy (irradiation dose was 18-50 Gy), and the median dose of conformal radiation therapy was 40 Gy (irradiation dose of 40-46 Gy) in the SBRT group. The dose of γ-ray stereotactic radiotherapy plus the median dose of radiation was 16 Gy (Irradiation dose 14 ~ 20 Gy). The overall median survival time was 8.4 months (survival time 1.4 to 35.1 months). The median survival time in 3D-CRT group and SBRT group was 8.2 months (survival time 1.4 to 21.2 months) and 17.7 months Survival time 2.9 to 35.1 months), P> 0.05. No significant difference was found between the two groups in the acute and late side effects of treatment. Conclusion For patients with locally advanced pancreatic cancer, conformal radiotherapy plus Gamma-ray stereotactic radiotherapy with a good amount of tolerance, there is a tendency to improve survival. Can really improve the survival rate, pending further expansion of sample research.