Acute Toxicity of Locally Advanced Pancreatic Carcinoma Treated with Intensity-Modulated Radiotherapy-A Preliminary Report

以強度調控順形放射治療治療局部侵犯性胰臟癌之急性副作用－初步報告

周英香(Ying-Hsiang Chou) ； 劉文山(Wen-Shan Liu) ； 曾顯群(Shien-Chun Tsen)

《放射治療與腫瘤學》 15卷1期 (2008/03) Pp. 9-19

https://doi.org/10.6316/TRO/200815(1)9

摘要

目的：本研究之目的在評估以強度調控順形治療治療局部侵犯性胰臟癌所引起之腸胃、血液性急性副作用。
材料與方法：自2001年1月至2005年12月止，一共有九位罹患局部侵犯性胰臟癌的病人在本院放射腫瘤科接受強度調控順形放射治療。其中有五位在放射治療期間合併使用化學治療。有一位病人在接受局部放射線治療前先接受了Whipple手術，還有一位病人在治療前先接受化學治療。九位病人中有八位罹患無法以手術完全清除之局部侵犯性腫瘤，有一位則是接受過手術切除後復發。四位患者在接受強度調控順形治療前先接受了局部傳統3D放射線治療，剩下的五位則是接受完整的強度調控順形治療。
結果：九位病人中，2年的整體存活率是33.3%，局部腫瘤控制率為53%。九位病人中有一位達到完全控制(complete response)，五位達到部分控制(partial response)而有三位的疾病持續進展(progressive disease)。九位病人中只有一位發生第三級的急性腸胃道副作用；有三位同時合併化學治療的病人發生了第三級的急性血液性副作用。所有的病人都成功的完成了治療，沒有需要鼻胃管置入進行營養補充的病人。有四位病人發生治療中斷的情形，平均治療中斷天數為14.5天。
結論：以強度調控順形放射治療合併或未合併化學治療治療局部侵犯性胰臟癌的病人，所觀察到的急性腸胃性及血液性副作用並不高。這個初步報告顯示對於局部侵犯性胰臟癌的病人，此一新式治療是可接受的治療方式。

關鍵字

胰臟癌 ； 強度調控順形治療 ； 急性副作用

並列摘要

Purpose: To evaluate the gastrointestinal and hematological toxicity of locally advanced pancreatic carcinoma treated mainly with intensity-modulated radiotherapy (IMRT).
Materials and Methods: A total of 9 locally advanced pancreatic carcinoma were treated with IMRT between June 2001 and December 2005. Five received concurrent chemotherapy. One patient received Whipple surgery before local irradiation, and one received chemotherapy prior to local irradiation. One presented with distant bone metastasis prior to radiation therapy. Eight out of nine patients had unresect-able primary and one had recurrent tumor. Four out of nine underwent treatment planning with conventional three-dimensional radiotherapy boost plus IMRT while others received solely IMRT.
Results: The 2-year expected overall survival was 33.3%. The local regional control rate was 53%. One out of 9 patients achieved complete response, 5 achieved partial response and 3 remained progressive disease. One out of 9 patients developed Grade 3 gastrointestinal toxicity. Three developed Grade 3 hematological toxicity, all with concurrent gemcitabine. No nasal-gastric tube support was needed among all patients. Interruption of treatment was noted within 4 patients with a median of 14.5 days.
Conclusion: In our study, the observed gastrointestinal and hematological toxicity rate was relatively low. This preliminary result showed that patient with locally advanced pancreatic carcinoma tolerated this new treatment approach well.

並列關鍵字

Pancreatic carcinoma ； Intensity-modulated radiotherapy ； Acute toxicity