术中电子线放疗或联合术后放化疗在不可切除局部晚期胰腺癌治疗中的作用

发布时间：2018-04-27 21:33

本文选题：胰腺肿瘤 + 术中电子线放射疗法　；参考：《北京协和医学院》2017年硕士论文

【摘要】：第一部分术中电子线放疗在不可切除局部晚期胰腺癌治疗中的作用目的利用术中电子线放疗(IOERT)精准照射肿瘤和保护正常组织及单次高剂量的优势,探索单纯术中放疗在不可切除局部晚期胰腺癌治疗中的作用。方法从2009年1月至2014年12月,共82例患者在本院仅行IOERT,因术中探查为不可切除的T3-4M0胰腺癌。IOERT剂量10-20Gy,中位剂量15Gy。按IOERT的剂量分为15Gy、15Gy和15Gy三组,分析其总生存(OS)、无进展生存(PFS)和肿瘤特异性生存、毒副反应。除高剂量(15Gy)组的KPS评分较高(P=0.003),肿瘤较小(P0.001)外,其它临床资料可比。结果生存患者中位随访时间423天。在单纯行术中放疗的82例患者中,中位OS期为8.1个月,1年OS率为40.4%;中位PFS 5.2个月,1年PFS率为26.8%;中位CSS期8.1个月,1年CSS率为42.6%。在IOERT剂量为15Gy、15Gy和15Gy三组中,其中位OS及1年OS率分别为6.2个月和10.0%、9.1个月和39.6%、22.2个月和77.4%(P0.001),显示IOERT剂量越高,生存越好。发生≥3级的重度胃肠道(2.4%)、腹痛(4.9%)、骨髓抑制(3.7%)毒副反应均在可耐受范围内,三组之间无统计学差异。单因素分析:IOERT剂量、肿瘤大小、年龄和KPS评分为影响预后因素(P0.001、0.033、0.040、0.023)。多因素分析示IOERT剂量为独立预后因素(P=0.001)。结论在局部晚期不可切除胰腺癌中,给予IOERT是安全有效的治疗手段;多因素分析IOERT剂量为独立预后因素。在治疗耐受性好或肿瘤较小,以及胃肠道不在照射范围内时,可适当增加IOERT剂量从而提高疗效。第二部分术中放疗联合术后放化疗在不可切除局部晚期胰腺癌中的疗效目的分析总结术中放疗联合体外放疗或同步放化疗的疗效和毒副反应,寻找提高术中不能切除胰腺癌的治疗方法。方法从2009年1月至2014年12月,65例术中探查为不可切除的T3-4M0胰腺癌,在本院行IOERT和术后联合EBRT或CCRT。IOERT剂量为10-15Gy,术后EBRT剂量为30-46Gy,同步化疗方案主要是吉西他滨300mg/m2每周方案。65例患者中12例IOERT+EBRT,另53例给予IOERT+CCRT的治疗,两组临床资料可比。分析两组之间的OS、PFS、不良反应等指标。结果生存患者中位随访时间772天。联合术后体外照射和联合术后同步放化疗两组的中位OS期及3年OS率分别为8.7个月和0.0%、11.6个月和11.3%(P=0.042)。其肿瘤特异性生存时间及3年的肿瘤特异性生存率分别为8.7个月、0.0%和11.8个月、11.5%(P=0.038)。两组的中位局部控制时间分别为7.9个月和9.6个月,1年的局部控制率分别为16.7%和34.0%(P=0.282)。中位远处转移控制时间为6.6个月和9.4个月,1年远转控制率为25.0%和37.7%(P=0.381)。两组发生≥3级的重度胃肠道、腹痛、骨髓抑制毒副反应均无统计学差异。单因素分析仅术后联合CCRT(P=O.042)为预后良好因素。结论相比IOERT联合EBRT,IOERT联合CCRT可延长局部晚期不可切除胰腺癌生存,延迟局部和远处转移时间,且重度毒副反应在可耐受范围内。第三部分术中放疗联合不同辅助治疗在不可切除局部晚期胰腺癌中的作用目的局部晚期胰腺癌推荐综合治疗。本研究比较IOERT及联合术后不同辅助治疗的生存、复发和治疗相关毒副反应情况,了解IOERT联合不同辅助治疗的价值和意义。方法从2009年1月至2014年12月,因术中探查不可切除的T3-4M0胰腺癌给予IOERT。IOERT剂量为10-15Gy。在79例术后联合不同辅助治疗方案中,12例IOERT+EBRT,53例IOERT+CCRT,14例给予IOERT+化疗(术中放疗联合化疗)。EBRT剂量为30-46Gy,同步化疗方案主要为吉西他滨300mg/m2每周方案。辅助化疗多样,其中以单药吉西他滨、吉西他滨联合卡培他滨化疗方案为主。结果生存患者中位随访时间748天。IOERT+EBRT、IOERT+CCRT和IOERT+化疗三组的中位OS期及2年OS率分别为8.7个月和0.0%、11.6个月和26.2%、11.5个月和11.4%(P=0.112)。仅比较IOERT+化疗和IOERT+CCRT之间的OS也无统计学差异(P=0.413)。两组的局部控制时间(6.8个月vs.9.6个月,P=0.577)和远转控制时间(7.2个月vs.9.4个月,P=0.699)虽无统计学差别,但显示同步放化疗组有更好的趋势。结论IOERT联合术后CCRT与IOERT联合化疗生存无统计学差异,中位生存期均可达到11.6个月;显示IOERT+CCRT不仅是安全可行的有效治疗方案,且疗效不差于化疗。
[Abstract]:Part 1 the role of electron beam radiotherapy in the treatment of unresectable locally advanced pancreatic cancer objective to explore the role of intraoperative radiotherapy (IOERT) for accurate irradiation of tumors, to protect normal tissues and to a single high dose, and to explore the role of intraoperative radiotherapy in the treatment of locally advanced locally advanced pancreatic adenocarcinoma. Methods from January 2009 to 201 In December 4 years, a total of 82 patients were treated with only IOERT in our hospital. The dose of.IOERT was 10-20Gy for the non resectable pancreatic cancer. The median dose 15Gy. was divided into 15Gy, 15Gy and 15Gy three groups according to the IOERT dose, and the total survival (PFS) and tumor specific survival and side effects were analyzed. 0.003), the tumor was smaller (P0.001), other clinical data were comparable. Results the median follow-up time of the survival patients was 423 days. The median OS period was 8.1 months and the 1 year OS rate was 40.4%; the median PFS 5.2 months, the 1 year PFS rate was 26.8%; the median CSS period was 8.1 months, and the CSS rate of the 1 year was 15Gy, 15Gy, and 15Gy three at 42.6%.. In the group, the OS and 1 year OS rates were 6.2 months and 10%, 9.1 months and 39.6%, 22.2 months and 77.4% (P0.001), which showed that the higher the IOERT dose, the better the survival. The severe gastrointestinal tract (2.4%), abdominal pain (4.9%), and the myelosuppression (3.7%) side reaction were all tolerable, and there was no statistical difference between the three groups. The single factor analysis: IOERT Dose, tumor size, age and KPS score were associated with prognostic factors (P0.001,0.033,0.040,0.023). Multivariate analysis showed that IOERT dose was an independent prognostic factor (P=0.001). Conclusion IOERT is a safe and effective treatment in locally advanced non resectable pancreatic cancer; multifactor analysis of IOERT dose is an independent prognostic factor. The effect of intraoperative radiotherapy combined with radiotherapy and chemoradiotherapy on unresectable locally advanced pancreatic cancer is analyzed and the efficacy and side effects of intraoperative radiotherapy combined with extracorporeal radiotherapy or concurrent chemoradiotherapy in the second part of the operation are analyzed. The results of the second part of the radiotherapy combined with radiotherapy and chemotherapy in the unresectable locally advanced pancreatic cancer. Methods to improve the treatment of unresectable pancreatic cancer during the operation. Methods from January 2009 to December 2014, 65 cases of unresectable T3-4M0 pancreatic cancer were explored. In our hospital, the dosage of IOERT and postoperative combined EBRT or CCRT.IOERT was 10-15Gy, the EBRT dose was 30-46Gy after operation, and the synchronous chemotherapy scheme was mainly the.65 case of gemcitabine 300mg/m2 weekly program. Of the 12 cases of IOERT+EBRT, the other 53 cases were treated with IOERT+CCRT, two groups of clinical data were comparable. The OS, PFS, and adverse reactions between the two groups were analyzed. The median follow-up time of the survival patients was 772 days. The median OS stage and the 3 year OS rate of the two groups after combined operation and postoperative combined radiotherapy and radiotherapy were 8.7 months and 0%, 11.6 months and 11.6 months, respectively. 11.3% (P=0.042). The tumor specific survival time and the 3 year tumor specific survival rate were 8.7 months, 0% and 11.8 months, 11.5% (P=0.038). The median local control time of the two group was 7.9 months and 9.6 months respectively. The local control rate of 1 years was 16.7% and 34% (P=0.282) respectively. The median distant metastasis control time was 6.6 months and 9.4. 1 years of 1 years of remote control rate was 25% and 37.7% (P=0.381). There was no significant difference in severe gastrointestinal tract, abdominal pain, and myelosuppression side effects in group two. Single factor analysis only combined with CCRT (P=O.042) as a good prognostic factor. Conclusion compared with IOERT combined with EBRT, IOERT combined with CCRT can prolong the survival of locally advanced non resectable pancreatic cancer. Delayed local and distant metastasis and severe toxic and side effects within tolerable range. Third part of the role of intraoperative radiotherapy combined with different adjuvant therapy in unresectable locally advanced pancreatic cancer recommended comprehensive treatment for locally advanced pancreatic cancer. This study compared the survival, recurrence and treatment of IOERT and combined postoperative adjuvant therapy. The value and significance of IOERT combined with different adjuvant therapy were observed. Methods from January 2009 to December 2014, IOERT.IOERT dose of IOERT.IOERT was given to T3-4M0 for non resectable pancreatic cancer from January 2009 to December 2014. 12 cases of IOERT+EBRT, 53 cases of IOERT+CCRT, and 14 cases were given IOERT+ chemotherapy. The.EBRT dose of intraoperative radiotherapy combined with chemotherapy was 30-46Gy, and the synchronous chemotherapy regimen was mainly gemcitabine 300mg/m2 weekly. The adjuvant chemotherapy was varied, among which the single drug gemcitabine, gemcitabine combined with capecitabine were the main chemotherapy regimens. The median follow-up time of survival patients was 748 days.IOERT+EBRT, IOERT+CCRT and IOERT+ chemotherapy in the middle OS. The OS rate in the period and 2 years was 8.7 months and 0%, 11.6 months and 26.2%, 11.5 months and 11.4% (P=0.112). There was no statistical difference between IOERT+ chemotherapy and IOERT+CCRT (P=0.413). The local control time (6.8 months vs.9.6 months, P=0.577) and remote control time (7.2 months vs.9.4 months, P=0.699) in the two group were not statistically different, but there was no statistical difference. It showed that there was a better trend in the concurrent chemoradiotherapy group. Conclusion there was no statistical difference between CCRT and IOERT after IOERT combined with chemotherapy, and the median survival time could reach 11.6 months. It showed that IOERT+CCRT was not only a safe and effective treatment scheme, but also the curative effect was not worse than chemotherapy.

【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.9

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