体部伽玛刀治疗晚期胰腺癌的临床分析

摘要

Objective :To evaluate the efficacy and safety of treating advanced pancreatic cancer ( PaC ) with whole - body stereotactic radiation treatment sytem ( gamma knife ). Methods: Total of 79 cases of advanced PaC were treated with gamma knife ( type SGS - 1 ). The margin of PTV was over 0.5cm - 1.0cm in GTV, 50％ -60％ dose line was prescribed dose curve and covered over 90％ area of PTV. Encircled dose of carcinoma which was less than or equal to 5cm was 3.5 -4.5Gy per fraction, of carcinoma which was greater than 5cm was 3.0 -4.0Gy per fraction.Majority were treated 5 days per week, 9 -11 fractions and at a total dose of 35 -48Gy was delivered at the tumor margin. Results:During the treatment of gamma knife period, significant pain relief has been observed in 88.9％ cases, and jaundice of 66.7％ cases has faded. After 3 months, CR was 1, PR 25. The overall response rate ( CR +PR) was 32.9％ and the rate of clinical benefit response( CBR )was 69.6％. The mean survival time was 5.7 months. The whole process was bearable for all the patients after allopathy. Conclusion: Gamma knife radiotherapy was a non -invasive, safe, and effective palliative therapy for advanced pancreatic cancer.%目的:探讨体部伽玛刀治疗晚期胰腺癌的安全性和有效性.方法:采用SGS-Ⅰ型立体定向伽玛射线体部治疗系统(体部伽玛刀)治疗79例晚期胰腺癌患者.伽玛刀治疗采用三维立体定向治疗计划系统给予患者精确定位.在临床靶区(CTV)边缘外放5mm-10mm形成计划靶区(PTV);等剂量线为50%-60%,肿瘤≤5cm的单次周边剂量3.5-4.5Gy,肿瘤>5 cm的单次周边剂量3.0-4.0Gy;治疗总剂量为35-48Gy;治疗次数9-11次,大多数患者为每周5次治疗.观察病人的有效率、生存时间和临床受益率(CBR).结果:伽玛刀治疗过程中88.9%患者上腹部及腰背部疼痛明显减轻;66.7%患者黄疸指数下降.CBR 69.6%.伽玛刀治疗3个月复查CT,病变部位达到CR 1例,PR 25例;总有效率(CR+PR) 32.9%.主要不良反应为:恶心,呕吐,骨髓抑制.结论:伽玛刀是治疗晚期胰腺癌的安全、有效的治疗方法.为临床肿瘤医师提供了一个新的治疗手段.