CAJ | 학술논문

目的：回顾性分析61例胰腺癌患者行常规三维适形放射治疗、随后缩野行放射治疗加量或γ射线体部立体定向放射治疗加量的疗效差异。方法：将61例胰腺癌患者按治疗方法分为三维适形放疗加量治疗组21例(三维-CRT组)和γ射线体部立体定向放疗加量治疗(SBRT加量组)40例。对61例胰腺癌患者先行常规三维适形放疗(胰腺病灶＋腹膜后淋巴结引流区域，TD40 Gy/20 Fx)后重新扫描；其中三维-CRT组针对胰腺病灶及腹膜后肿大淋巴结放射治疗加量至TD46～50 Gy；SBRT加量组使用γ射线体部立体定向放射治疗加量治疗追加14～16 Gy，共7～8次。结果：两组总中位生存时间为11.3个月，1年总生存率为44.95%。单因素分析显示，卡氏评分(KPS)≥90分、接受过化疗及女性患者疗效更佳，其中位生存时间差异有统计学意义(x2=8.992，x2=4.056， x2=3.953；P＜0.05)。三维-CRT组与SBRT加量组的中位生存时间分别为7.5个月和13.0个月，两组治疗相关急性和后期副反应无差异。结论：适形放射治疗加γ射线立体定向放射治疗加量对于局部晚期胰腺癌患者而言耐受性好，有提高患者生存期的趋势。放射治疗前KPS评分高、放射治疗联合化疗以及女性患者可能获得更好的疗效。
목적：회고성분석61례이선암환자행상규삼유괄형방사치료、수후축야행방사치료가량혹γ사선체부입체정향방사치료가량적료효차이。방법：장61례이선암환자안치료방법분위삼유괄형방료가량치료조21례(삼유-CRT조)화γ사선체부입체정향방료가량치료(SBRT가량조)40례。대61례이선암환자선행상규삼유괄형방료(이선병조＋복막후림파결인류구역，TD40 Gy/20 Fx)후중신소묘；기중삼유-CRT조침대이선병조급복막후종대림파결방사치료가량지TD46～50 Gy；SBRT가량조사용γ사선체부입체정향방사치료가량치료추가14～16 Gy，공7～8차。결과：량조총중위생존시간위11.3개월，1년총생존솔위44.95%。단인소분석현시，잡씨평분(KPS)≥90분、접수과화료급녀성환자료효경가，기중위생존시간차이유통계학의의(x2=8.992，x2=4.056， x2=3.953；P＜0.05)。삼유-CRT조여SBRT가량조적중위생존시간분별위7.5개월화13.0개월，량조치료상관급성화후기부반응무차이。결론：괄형방사치료가γ사선입체정향방사치료가량대우국부만기이선암환자이언내수성호，유제고환자생존기적추세。방사치료전KPS평분고、방사치료연합화료이급녀성환자가능획득경호적료효。
Objective:To analyze retrospectively the different efficacy between linear accelerator X-ray with three-dimensional conformal radiotherapy(3D-CRT) and dose boosted with gamma ray stereotactic body radiotherapy(SBRT) for locally advanced pancreatic cancer patients. Methods:A total of 61 patients with locally advanced pancreatic cancer were enrolled. All the patients were first performed by 3D-CRT, the volumes of irradiation included the pancreatic tumor (GTV) and the draining lymph node region, total scheduled dose was 40Gy in 20 fractions. Then boosted the dose to GTV, 21 cases with 3D-CRT(3D-CRT group), total dose of 46Gy;40 cases with SBRT(SBRT group), total dose of 56Gy. Results:The median survival time was 11.3 months for all cases. Patients with pretreatment KPS≥90, combined with chemotherapy and femal had better prognosis. The corresponding MSTs were 14.1 months vs 9.2 months(x2=8.992, P=0.003),13.0 months vs 9.6 months(x2=4.056, P=0.044) and 12.5 months vs 10.7 months(x2=3.953, P=0.047) respectively. The median survival time of 3D-CRT group and SBRT group were 7.5 months and 13 months, P<0.05. There were no statistic differences between 2 groups in terms of side effects induced by treatments. Conclusion:The gamma ray stereotactic body radiotherapy is effective and safe and has the trend to improve the survival rate for patients with locally advanced pancreatic cancer. Patients with better performance status before treatment, combined with chemotherapy and female may have better prognosis.