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根治性放疗为主综合治疗不能手术的Ⅰ-Ⅲ期胰腺癌预后分析
曹必样1,2, 刘小亮2, 张乐天1,2, 吴陈陈1,2, 杨微2, 王倩倩2, 童芳2, 王竞2
1解放军医学院,北京 100853; 2解放军总医院第一医学中心放射治疗科,北京 100853
Long-term outcomes of definitive radiotherapy-based comprehensive treatment for inoperable stage I-III non-metastatic pancreatic cancer
Cao Biyang1,2, Liu Xiaoliang2, Zhang Letian1,2, Wu Chenchen1,2, Yang Wei2, Wang Qianqian2, Tong Fang2, Wang Jing2
1Chinese PLA Medical School, Beijing 100853, China; 2Department of Radiation Oncology, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
Abstract：Objective To analyze long-term outcomes of inoperable non-metastatic pancreatic cancer patients treated with definitive radiotherapy-based comprehensive treatment. Methods Clinical data of 168 patients with medically unfit, refusal to surgery or inoperable non-metastatic pancreatic cancer treated with radiotherapy-based comprehensive treatment in PLA General Hospital between January 2016 and December 2020 were retrospectively analyzed. Survival outcomes,prognostic factors and patterns of treatment failure were analyzed in the radiotherapy (n=95) and combined chemoradiotherapy (n=73) groups. The survival analysis was conducted by Kaplan-Meier method. The survival curve was compared by log-rank test. Independent prognostic factors were identified by Cox proportional harzard model. Results With a median follow-up of 20.2 months in the entire group, the median overall survival (OS) and median progression-free survival (PFS) were 18.0 and 12.3 months. The corresponding median OS and median PFS after receiving radiotherapy were 14.3 and 7.7 months. The 1-, 2-and 3-year OS rates were 72.1%, 36.6% and 21.5%, and the 1- and 2-year local control rates were 82.6% and 64.3%, respectively. The median OS for stage Ⅰ, stage Ⅱ and stage III were 27.1, 18.0 and 17.0 months, respectively. There was no significant difference in the median OS of patients with localized disease (stage Ⅰ-Ⅱ) between the radiotherapy and combined chemoradiotherapy groups (21.1 vs. 20.4 months, P=0.470). In patients with locally advanced disease (stage Ⅲ), combined chemoradiotherapy group showed better median OS compared with radiotherapy group (19.2 vs. 13.8 months, P=0.004). Clinical stage, CA19-9 before radiotherapy, comprehensive treatment and biological effective dose (BED10) were identified as the independent prognostic factors for OS (P=0.032, 0.011, 0.003 and 0.014). The cumulative 1- and 2-year actuarial rates of treatment failure, local-regional recurrence and distant metastasis were 48% and 74.4%, 15.0% and 27.4%, 23.6% and 33.1%, respectively. Liver metastasis (16.1%, 27/168) and local recurrence (11.9%, 20/168) were the primary patterns of treatment failure. Conclusions Definitive radiotherapy-based comprehensive treatment effectively prolongs long-term survival in patients with inoperable non-metastatic pancreatic cancer. Definitive radiotherapy can be an alternative treatment option with curative intent for patients with localized pancreatic cancer who are medically unfit or refuse to undergo surgery. The combination of radiotherapy and chemotherapy remains an effective treatment choice for locally advanced unresectable pancreatic cancer.
Cao Biyang,Liu Xiaoliang,Zhang Letian et al. Long-term outcomes of definitive radiotherapy-based comprehensive treatment for inoperable stage I-III non-metastatic pancreatic cancer[J]. Chinese Journal of Radiation Oncology, 2023, 32(5): 407-414.
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