Clinical efficacy observation of stereotactic radiation therapy combined with gemcitabine for advanced pancreatic carcinoma / 肿瘤研究与临床

ABSTRACT

Objective To seek the curative effect of stereotactic radiation therapy (SRT) combined with gemcitabine for unresectable advanced pancreatic carcinoma.Methods 24 patients were treated by SRT of 6MV X-ray.Patients were fixed with the rack of stereotactic localization and heated plastics mould.The CT scanning results were put into the treatment planning system.According to the target area of tumor,sensitive organs and moving error drew GTV,CTV and PTV.The best plan was selected by the dose-volume histogram (DVH).5 to 7 beams of non-coplanar radiation ray were chosen.PTV was surrounded by ≥95 ％ isodose curves.Conventional fraction,5 fractions per week,1.8-2 Gy per fraction was used.All patients received a total dose of 50-60 Gy.Gemcitabine was performed 1000 mg/m2,once a week,iv gtt,in the 1st,2nd and 4th,5 th weeks.Results In chemo-radiotherapy,50.0 ％ (12/24) patients showed light nausea,41.7 ％ (10/24) patients showed leucopenia or thrombocytopenia of grade 1 or 2,after symptomatic treatment,all patients completed the planned treatment.In a period of one month to three months,after SRT combined with chemotherapy,appetite improvement was 83.3 ％ (20/24),jaundice disappeared in 6 of 6 patients (100.0 ％),abdominal pain was relieved in 21 of 24 patients (87.5 ％),3 patients were relieved completely among them.The complete remission (CR) rate was 16.7 ％ (4/24) and partial remission (PR) rate was 66.7 ％ (16/24),with CR+PR rate of 83.4 ％ (20/24).One-year survival rate was 70.8 ％ (17/24).As a consequence of cachexia,intestinal obstruction or bleeding,7 patients died within one year.Nobody survived more than 2 years.Conclusions SRT combined with gemcitabine for advanced pancreatic carcinoma may relieve symptoms.It is an effective approach to improve life quality and prolong survival time for advanced pancreatic carcinoma,especially lod and weak patients are more suitable to select SRT combined with gemcitabine.