摘要
目的观察评价全身γ刀治疗局限期胰腺癌的疗效和放射治疗副反应。方法对采用全身γ刀治疗的111例局限期胰腺癌患者行回顾性分析。患者仰卧位，用体位固定床和真空负压袋固定，在自主呼吸下行慢增强CT定位扫描。在CT图像上分别勾画GTV、CTV和PTV，治疗计划以50％等剂量线覆盖100％的PTV，70％等剂量线覆盖80％以上的GTV为计划要求，以50％等剂量线为处方剂量。胰头癌3～4Gy/次、胰体尾癌4—5Gy/次，5次／周，PTV边缘总剂量40～51Gy，GTV边缘60～70Gy。结果原发灶完全缓解率为29．7％，部分缓解率为42．3％，总有效率为72．1％。随访率为95．5％，随访时间满1、2、3年总例数105、89、60例，1、2、3年总生存率分别为49．3％、24．5％、18．1％。Ⅰ＋Ⅱ期随访满1、2、3、4、5年例数分别为55、44、29、16、11例，1、2…3、4、5年总生存率分别为68％、34％、30％、21％、17％；Ⅲ期随访满1、2、3年例数分别为50、45、31例，1、2、3年总生存率分别为28％、14％、4％（χ2=16．67，P=0．000）。治疗副反应主要是急性胃肠道反应，如恶心、呕吐、腹泻，多数可耐受，1～2级急性胃肠道反应发生率为71．2％，3级为3．6％，经对症处理后患者均能按计划完成治疗。结论全身γ刀治疗胰腺癌采用3—5Gy/次，5次／周，PTV边缘50％等剂量线处总剂量40～51Gy的治疗模式是安全有效的，对局限期胰腺癌可获得较好疗效。
[Objective To evaluate the efficacy and side effects of whole body γ-knife in patients with limited pancreatic carcinoma. Methods 111 patients with limited pancreatic carcinoma treated with the Stereotactic Gamma Ray Whole-Body Therapeutic System （Whole Body γ-knife） were retrospectively analyzed. Patients were supine, fixed with a stereotactic body frame and vacuum bag, and then simulated by low-speed computed tomography. GTV, CTV and PTV were defined on the contrast-enhanced CT scans. It was required that 50% isodose line covered 100% of PTV and 70% isodose line covered more than 80% of GTV. The prescription dose was defined as 50% isodose. All patients were treated 5 fractions per week. The fractionated dose was 3 - 4 Gy for pancreatic head carcinoma, and 4 - 5 Gy for pancreatic body/tail carcinoma. Irradiation of 40 -51 Gy and 60 -70 Gy were delivered to PTV and GTV margins, respectively. Resuits The complete response rate, partial response rate and overall response rate of the primary tumors were 29.7%, 42.3% and 72.1%, respectively. The follow-up rate was 95.5%. The number of patients followed-up at 1-,2- and 3-year was 105,89 and 60. The 1-, 2- and 3-year overall survival rates were 49.3%, 24.5% and 18.1%. For patients with stage Ⅰ/Ⅱ disease, the number of patients followed-up at 1-,2-,3-, 4- and 5-year was 55,44,29,16 and 11 ; The 1-, 2-, 3-, 4- and 5-year overall survival rates were 68%, 34%, 30%, 21% and 17%, respectively. For patients with stage Ⅲ disease, the number of patients fol- lowed-up at 1-,2- and 3-year was 50,45 and 31 ;The 1-, 2- and 3-year overall survival rates were 28%, 14% and 4%, respectively （ χ2 = 16.67, P = 0.000）. The acute side effects including nausea, vomiting and diarrhea were 71.2% of RTOG grade 1 -2 and 3.6% of RTOG grade 3. No treatment delay occurred. Conclusions With fractionated dose of 3 -5 Gy,5 fractions per week and 40 -51 Gy as total dose to PTV, whole body γ-knife is safe and effective to treat limited pancreatic carcinoma. The local control and overall survival could be improved.
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2009年第6期470-473,共4页
Chinese Journal of Radiation Oncology
关键词
胰腺肿瘤/放射疗法
放射疗法
Γ刀
预后
Pancreatic neoplasms/radiotherapy
Radiotherapy,γ-knife
Prognosis
