CAJ | 학술논문

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3～4 Gy/次、胰体尾癌4～5 Gy/次,5次/周,PTV边缘总剂量40～51 Oy,GTV边缘60～70 Gy.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%(χ~2=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3～5 Gy/次,5次/周,PTV边缘50%等剂量线处总剂量40～51 Gy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.
목적 관찰평개전신γ도치료국한기이선암적료효화방사치료부반응.방법 대채용전신γ도치료적111례국한기이선암환자행회고성분석.환자앙와위,용체위고정상화진공부압대고정,재자주호흡하행만증강CT정위소묘.재CT도상상분별구화GTV、CTV화PTV,치료계화이50%등제량선복개100%적PTV,70%등제량선복개80%이상적GTV위계화요구,이50%등제량선위처방제량.이두암3～4 Gy/차、이체미암4～5 Gy/차,5차/주,PTV변연총제량40～51 Oy,GTV변연60～70 Gy.결과 원발조완전완해솔위29.7%,부분완해솔위42.3%,총유효솔위72.1%.수방솔위95.5%,수방시간만1、2、3년총례수105、89、60례,1、2、3년총생존솔분별위49.3%、24.5%、18.1%.Ⅰ+Ⅱ기수방만1、2、3、4、5년례수분별위55、44、29、16、11례,1…2 3 4、5년총생존솔분별위68%、34%、30%、21%、17%;Ⅲ기수방만1、2、3년례수분별위50、45、31례,1、2、3년총생존솔분별위28%、14%、4%(χ~2=16.67,P=0.000).치료부반응주요시급성위장도반응,여악심、구토、복사,다수가내수,1～2급급성위장도반응발생솔위71.2%,3급위3.6%,경대증처리후환자균능안계화완성치료.결론 전신γ도치료이선암채용3～5 Gy/차,5차/주,PTV변연50%등제량선처총제량40～51 Gy적치료모식시안전유효적,대국한기이선암가획득교호료효.
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 Stereotactie Gamma Ray Whole-Body Therapeutic System (Whole Body T-knife) were retrospectively an-alyzed. 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% isedose line covered 100% of PTV and 70% isedose 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 carcino-ma. Irradiation of 40-51 Gy and 60-70 Gy were delivered to PTV and GTV margins, respectively. Re-suits 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 fol-lowed-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 (χ~2=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.