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目的观察三维适形放射治疗(3D-CRT)联合吉西他滨(GEM)+氟脲嘧啶(5-FU)方案(GF方案)同期治疗局部晚期胰腺癌的疗效和毒性反应。方法 39例局部晚期胰腺癌患者随机分为同期放化疗组(A组,19例)和序贯放化疗组(B组,20例)。所有患者化疗予以GEM 800 mg/m2,5-FU 500 mg/m2,d1、d8、d15。应用5-FU前常规予以亚叶酸钙(FA)200 mg加入生理盐水250 ml中静脉滴注,28 d为1周期,连续2周期。给予3D-CRT放疗,常规分割,每次2 Gy,每周5次,3~6.5周,总剂量30~64 Gy。结果 39例患者全部完成治疗计划。A、B组有效(CR+PR)率分别为73.7%、40.0%(P<0.05);A、B组中位生存时间分别为12.3个月和9.6个月(P<0.05)。两组患者的毒副反应相当,均未出现严重的放化疗并发症。结论 3D-CRT加同期GF化疗治疗局部晚期胰腺癌能明显提高患者的生活质量和生存期,不良反应能为大多数患者耐受。
Objective To observe the efficacy and toxicity of concurrent 3D-CRT with gemcitabine (GEM) + fluorouracil (GF) regimen in the treatment of locally advanced pancreatic cancer. Methods Thirty-nine patients with locally advanced pancreatic cancer were randomly divided into concurrent chemoradiotherapy (group A, n = 19) and sequential radiotherapy and chemotherapy (group B, n = 20). All patients received chemotherapy with GEM 800 mg / m2, 5-FU 500 mg / m2, d1, d8, d15. Before the application of 5-FU conventional leucovorin (FA) 200 mg added 250 ml of normal saline intravenously, 28 d for a period of 2 consecutive weeks. Given 3D-CRT radiotherapy, conventional segmentation, each 2 Gy, 5 times a week, 3 to 6.5 weeks, the total dose of 30 to 64 Gy. Results All 39 patients completed the treatment plan. The effective rates of CR + PR in group A and group B were 73.7% and 40.0%, respectively (P <0.05). The median survival time in group A and group B was 12.3 months and 9.6 months respectively (P <0.05). Toxic side effects in both groups were quite similar, and no serious radiotherapy and chemotherapy complications occurred. Conclusions 3D-CRT plus concurrent chemotherapy with GF in the treatment of locally advanced pancreatic cancer can significantly improve the quality of life and survival of patients, adverse reactions can be tolerated in most patients.