吉西他滨和西妥昔单抗联合放疗治疗局部晚期胰头癌的疗效分析

摘要

目的:评估吉西他滨和西妥昔单抗联合放疗靶向治疗局部晚期胰头癌的疗效.方法:收集2008年11月到2012年1月145例经组织学确诊的胰腺导管腺癌患者参与本项研究.所有患者接受三维适形放射治疗,常规分割1. 8 Gy/(f·d),5次/周,总照射剂量50. 4 Gy.放疗开始的同一天给予每周300 mg/m2吉西他滨,第1天400 mg/m2西妥昔单抗,后续每周250 mg/m2西妥昔单抗.结果:全部患者完成放化疗,59例(40. 7%)CR,49例(33. 8%)PR,35例(24. 1%)SD,2例(1. 4%)PD,总有效率为74. 5%.2年无转移生存率为27%(中位13.6个月,95%CI:2.8～27.1).1年和2年总生存率分别为68. 3%和27.8%,中位总生存期为14. 9个月(95%CI:10. 3～20. 7);1年和2年无进展生存率分别为41. 5%和19. 8%,中位无进展生存期10. 2个月(95%CI:9. 2～18. 0).治疗后血液系统出现Ⅲ-Ⅳ级毒副反应(44. 8%白细胞减少症、4. 8%血小板减少、21. 4% γ-GT升高和0. 7%碱性磷酸酶升高).Ⅲ-Ⅳ级非血液毒性较少出现.结论:吉西他滨和西妥昔单抗联合放疗治疗局部晚期胰头癌具有一定疗效,能显著改善患者的临床症状,且毒副反应均能耐受.%Objective:To evaluate the efficacy of gemcitabine and cetuximab combined with radiotherapy in local-ly advanced pancreatic head cancer. Methods:From November 2008 to January 2012,the study included 145 pa-tients with pancreatic head cancer . All the patients underwent three -dimensional conformal radiotherapy ,conven-tional segmentation 1. 8 Gy/(f·d),5 times/week,a total dose of 50. 4 Gy. Gemcitabine 300 mg/m2,per week and cetuximab 400 mg/m2,d1(follow up 250 mg/m2,per week)were given during radiation therapy . Results :All the patients completed chemo -radiotherapy. There were 59 cases (40. 7%)CR,49 cases (33. 8%)PR,35 cases (24. 1%)SD and 2 cases (1. 4%)PD,and total effective rate was 74. 5%. 2-year metastases-free survival rate was 27%(median of 13. 6 months,95%CI:2. 8～27. 1). 1-year and 2-year overall survival rate were 68. 3% and 27. 8% respectively,with a median survival time of 14. 9 months (95%CI:10. 3～20. 7). 1-year and 2-year pro-gression-free survival rate were 41. 5% and 19. 8% respectively,with a median survival time of 10. 2 months (95%CI:9. 2～18. 0). The blood system appearedⅢ-Ⅳgrade toxicity (leukopenia 44. 8%,thrombocytopenia 4. 8%,el-evated γ-GT 21. 4% and alkaline phosphatase 0. 7%)after treatment. Non-hematologic toxicity of grade Ⅲ-Ⅳwas less. Conclusion:The gemcitabine and cetuximab combined with radiotherapy provides a feasible and well tolera-ted treatment for locally advanced pancreatic head cancer,and it also can improve the clinical symptoms of patients.