Efficacy of high-dose hypofractionated radiotherapy in elderly patients with stage Ⅳ pancreatic cancer
-
摘要:
目的评估高剂量少分次放疗模式治疗老年Ⅳ期胰腺癌的疗效及毒副反应。方法收集2011年9月-2015年5月于中国人民解放军空军总医院肿瘤放疗科就诊的胰腺癌伴远处转移患者的临床资料,所有患者接受螺旋断层放疗高剂量少分次模式治疗。通过随访获取疗效及毒副反应,依据NCI-CTCAE 4.02标准行不良反应评价。生存分析采用Kaplan-Meier法。结果共33例65岁以上患者接受高剂量少分次模式放疗,30例获得随访,获访率91.0%,其中位生存时间9个月,1年生存率为24.0%,疼痛缓解率80.0%(20/25)。17例患者可评价胰腺病灶治疗效果,其中部分缓解4例(23.5%),稳定12例(70.6%),进展1例(5.9%)。毒副反应中血液学反应3级占6.7%(2/30),无2级以上消化道反应。结论采用高剂量少分次模式治疗老年Ⅳ期胰腺癌,副反应可接受,可缓解患者癌痛,有延长生存时间的趋势。
Abstract:Objective To investigate the efficacy and toxic and adverse effects of high- dose hypofractionated radiotherapy in elderly patients with stage Ⅳ pancreatic cancer. Methods The clinical data of the patients with pancreatic cancer and distant metastasis who were admitted to our hospital from September 2011 to May 2015 were collected,and all the patients underwent high- dose hypofractionated helical tomotherapy. The data on efficacy and toxic and adverse effects were obtained through follow- up,and the evaluation of adverse effects was performed according to National Cancer Institute- Common Terminology Criteria for Adverse Events version 4. 02. The Kaplan- Meier method was used for survival analysis. Results A total of 33 patients older than 65 years received the high- dose hypofractionated radiotherapy.Of all the patients,30 received follow- up visits,and the follow- up rate was 91. 0%. The median survival time was 9 months,the 1- year overall survival rate was 24. 0%,and the rate of pain relief was 80. 0%( 20 /25). The treatment outcome of pancreatic lesions could be evaluated in 17 patients,among whom 4( 23. 5%) achieved partial remission,12( 70. 6%) achieved stable disease,and 1( 5. 9%) experienced progression. As for toxic and adverse effects,the incidence rate of grade 3 hematologic toxicity was 6. 7%( 2 /30),and no patients experienced grade > 2 upper gastrointestinal reactions. Conclusion In elderly patients with stage IV pancreatic cancer,high- dose hypofractionated radiotherapy has tolerable toxic and adverse effects and can relieve cancer pain and prolong survival time.
-
Key words:
- pancreatic neoplasms /
- dose fractionation /
- prognosis /
- aged
-
[1]CANNISTRA M,RUGGIERO M,ZULLO A,et al.Metastases of pancreatic adenocarcinoma:A systematic review of literature and a new functional concept[J].Int J Surg,2015,21(Suppl 1):s15-s21. [2]CONROY T,DESSEIGNE F,YCHOU M,et al.FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer[J].N Engl J Med,2011,364(19):1817-1825. [3]GOLDSTEIN D,EL-MARAGHI RH,HAMMEL P,et al.nab-Paclitaxel plus gemcitabine for metastatic pancreatic cancer:long-term survival from a phaseⅢtrial[J].J Natl Cancer Inst,2015,107(2).Pii:dju413. [4]REN G,XIA T,WANG Y.IMRT with capecitabine in advanced pancreatic cancer.In regard to Passoni et al[J].Int J Radiat Oncol Biol Phys,2014,89(2):431. [5]XIA T,CHANG D,WANG Y,et al.Dose escalation to target volumes of helical tomotherapy for pancreatic cancer in the phase I-II clinical trial[J].Int J Radiat Oncol Biol Phys,2013,87(Suppl):s303. [6]MAHADEVAN A,MIKSAD R,GOLDSTEIN M,et al.Induction gemcitabine and stereotactic body radiotherapy for locally advanced nonmetastatic pancreas cancer[J].Int J Radiat Oncol Biol Phys,2011,81(4):e615-e622. [7]WANG J,XIA T,WANG Y,et al.Long-term results of gamma ray-based stereotactic body radiotherapy in treatment of medically unfit or inoperable non-metastatic pancreatic adenocarcinoma[J].Int J Radiat Oncol Biol Phys,2012,84(Suppl):s815-s816. [8]REN G,WANG J,XIA TY.Interpretation of radiotherapy document in Chinese expert consensuson comprehensive diagnosis and treatment of pancreatic cancer(2014 Edition)[J].J Clin Hepatol,2014,30(12):1249-1252.(in Chinese)任刚,王竞,夏廷毅.《胰腺癌综合诊治中国专家共识(2014年版)》放疗部分解读[J].临床肝胆病杂志,2014,30(12):1249-1252. [9]LIN JC,JEN YM,LI MH,et al.Comparing outcomes of stereotactic body radiotherapy with intensity-modulated radiotherapy for patients with locally advanced unresectable pancreatic cancer[J].Eur J Gasteroenterol Hepatol,2015,27(3):259-264. [10]YECHIELI RL,ROBBINS JR,MAHAN M,et al.Stereotactic body radiotherapy for elderly patients with medically inoperable pancreatic cancer[J].Am J Clin Oncol,2014.[Epub ahead of print] [11]KIM CH,LING DC,WEGNER RE,et al.Stereotactic body radiotherapy in the treatment of pancreatic adenocarcinoma in elderly patients[J].Radiat Oncol,2013,8:240. [12]PAN Y,LIU LM,CHEN Z,et al.Prognostic analysis of 190 elgerly patients with pancreatic cancer treated by integrated traditional chinese and western medicine therapy[J].J Clin Hepatol,2014,30(4):330-334.(in Chinese)潘岩,刘鲁明,陈震,等.中西医结合治疗190例老年胰腺癌的预后分析[J].临床肝胆病杂志,2014,30(4):330-334. -

计量
- 文章访问数: 1991
- HTML全文浏览量: 8
- PDF下载量: 497
- 被引次数: 0