Outcome of Radiotherapy in Histologically Confirmed Neoplasms of the Pancreas

組織切片證實為胰臟癌的放射治療成果

吳沅樺(Yuan-Hua Wu) ； 林炳文(Pin-Wen Lin) ； 蘇五洲(Wu-Chou Su) ； 陳海雯(Helen H. W. Chen)

《放射治療與腫瘤學》 11卷2期 (2004/06) Pp. 81-89

https://doi.org/10.6316/TRO/200411(2)81

摘要

目的：大多數的胰臟癌在疾病診斷之初即為局部侵犯厲害的晚期病人，能選擇的治療方法並不多，我們以回溯性的方式報告組織切片證實為胰臟癌之放射治療成果。 材料與方法：從1992年到2002年6月，共有32位組織切片證實為胰臟癌的病人在本院接受放射線45到64 Gy的體外放射治療（中位數為50.4 Gy）。其中8位病人為可切除之腫瘤，因為手術無法切除乾淨或是有局部淋巴結轉移而接受術後放射線照射；8位病人在疾病診斷之初即遠端轉移至肝、肺和頸部淋巴結；另外16位則為局部腫瘤侵犯厲害無法手術切除之患者。組織型態則以腺癌（28位病人）為最常見，其餘依次為惡性神經內分泌瘤（2人）、囊腺癌（1人）和黏液性癌（1人）。28位病人（88%）接受含5-FU或是gemcitabine的化學治療，多與放射治療合併同時給予。 結果：病人的整體存活率第一年為31.3%，第二年為10.7%。腺癌比非腺癌的病人有較差的存活率（中位數為7.6月和22.2月；P值為0.04）。在28位腺癌的病人中，接受手術切除腫瘤者，比腫瘤無法手術切除者或遠端腫瘤轉移者，有較佳的存活率（中位數為10.9月比8.3月比 2.8月；P值為0.003），肝臟為最易好發之遠端轉移處（11位病人，35%）。 結論：即使放射治療對手術可切除之胰臟癌有相對較佳的臨床治療成果，胰臟癌的放射治療效果仍然很差，未來對這個疾病需要更多新藥和新的治療模式的合併治療。

關鍵字

胰臟癌 ； 放射治療 ； 臨床治療成果

並列摘要

Purpose : Treatment options for pancreatic cancer remain limited due to the large proportion of patients presenting with advanced disease at the time of diagnosis. This retrospective study is to report our result in treating pancreatic cancer with radiotherapy. Material and Methods : From 1992 to June 2002, 32 patients with tissue-proven neoplasms of the pancreas were treated with external-beam radiotherapy to a dose of 45 to 64 Gy (median, 50.4 Gy). Eight patients with resectable tumors received post-operative radiotherapy for margin or node positive. Eight had initial metastatic disease in the liver, lung or neck lymph nodes. The remaining 16 patients had unresectable, locally advanced tumors. Adenocarcinoma was the most common histologic type (28 patients), followed by neuroendocrine tumor (2), cystadenocarcinoma (1) and mucinous carcinoma (1). Chemotherapy with 5-FU or gemcitabine base was given to 28 (88%) patients, most concurrently. Result : The overall survival rate for all patients was 31.3% at 1 year and 10.7% at 2 years. Those with adenocarcinomas had a poorer survival than those with non-adenocarcinomatous tumors (median: 7.6 vs. 22.2 months, P = 0.04). Among the 28 adenocarcinoma patients, survival was significantly better for those with resectable tumors, as compared to unresectable and metastatic tumors (median: 10.9 vs. 8.3 vs. 2.8 months, P = 0.0003). The liver was the most common site of distant metastasis in 11 patients (35%). Conclusion : Despite the relatively favorable prognosis of radiotherapy for resectable compared with unresectable and metastatic pancreatic cancers, the survival of patients after radiotherapy is still dismal. New approaches using novel agents and combined treatment modalities are necessary to change the dismal outlook of the disease.

並列關鍵字

Pancreatic neoplasms ； Radiotherapy ； Clinical outcome