- 期刊
Outcome of Gemcitabine Based Chemoradiation for Loco-Regional Cholangiocarcinoma
局部區域型膽道癌之gemcitabine同步化放療
摘要
目的：目前膽道癌的治療仍以手術為主，而同步化放療治療則用於術後之輔助性治療，或在無法手術切除病灶之病患。文獻中所記載之同步化放療療法仍以flourauracil為主，以gemcitabine進行治療者著墨不多。本文乃對於本院接受gemcitabine行同步化放療病人進行回溯性分析。材料及方法：從2004年4月至2012年12月，共有26位新診斷膽管癌病患（男／女=17／9；年齡中位數：66歲）於本院接受以gemcitabine為主的根治性同步化放療。當中22位病患體能狀態為ECOG 0-1、4位為ECOG 2，9位有淋巴轉移病灶、17位無淋巴轉移病灶。Gemcitabine使用劑量為每週或隔週 400 mg／m2，放射線劑量中位數為52.0 Gy（40－72.1 Gy）。以單變項及多變項分析找出可能的預後因子。結果：所有病患的平均存活期為13.2月，一年及二年存活率分別為53%以及8%。在單變項分析中，體能狀態為ECOG 0-1者較ECOG 2者之存活期存在顯著差異（16.9月vs. 1.5月，p=0.045）。年齡（＜ 66歲）雖然對平均存活期有正面影響，但未達顯著統計差異（28.0月vs.4.8月，p=0.055）。在腫瘤區復發者共八位，其中二位為單純腫瘤復發。因治療副作用死亡者共兩位。結論：以gemcitabine進行膽道管癌的同步化放療是可行的治療方式，可做為手術之外的主要治療方式。體能狀態良好的病人應可由本治療得到較長的生存期。
並列摘要
Purpose: Surgery remains the primary treatment of cholangiocarcinoma, with concurrent chemoradiation (CCRT) reserved for adjuvant treatment or as primary treatment for unresectable disease. However, the experience has been limited to flourauracilbased chemoradiation. A retrospective analysis of gemcitabine based CCRT as primary treatment for loco-regional cholangiocarcinoma in our institute was performed. Materials and Methods: Between April, 2004 and December, 2012, 26 patients (M/F=17/9; median age=66years) with cholangiocarcinoma (14 intrahepatic primary and 12 perihilar or extrahepatic primary) were treated with curative intent at our department. Baseline performance status based on Eastern Cooperative Oncology Group (ECOG) was 0-1 in 22 patients and 2 in 4 patients. Nine had regional extension of the diseases (defined as metastasis in either regional or para-aortic lymph nodes), whereas 17 had localized (T1-4N0M0) disease. The median equivalent dose in 2 Gy (EQD2) was 52.0 Gy (range: 40-72.1 Gy). Concurrent chemotherapy was low dose gemcitabine at 400 mg/m2 given weekly to biweekly. Both univariateand multivariate analyses were used to identify statistically significant prognostic factors. Results: The median survival of the entire cohort was 13.2 months. Survival rates at 1 and 2 year were 53% and 8% respectively. Patients of better performance status (ECOG 0-1) had improved median survival in comparison to those who of poorer baseline performance status (ECOG 2) (16.9 months vs. 1.5 months, p=0.045) on univariate analysis. Younger age (＜ 66 years) trended towards improved median survival (28.0 months vs. 4.8 months, p=0.055). There was eight local failures, two of which were isolated local failures. There were two treatment-related deaths. Conclusions: Outcome of low dose gemcitabine CCRT for cholangiocarcinoma seems promising. Those with better baseline performance status are most likely to benefit from this treatment. Definitive gemcitabine based CCRT for loco-regional cholangiocarcinoma may be an alternative to primary surgery.
延伸閱讀
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