We studied the use of palliative radiotherapy (RT) among patients with primary, non-curable, locally advanced pancreatic cancer. In this subset of patients, with very poor survival, various palliative RT dose fractionation schemes are used; but, in the absence of a guideline, practice patterns vary, and dose choice is mainly based on the physician’s intuition. We divided the patients into three groups, according to the dose fractionation schedules received: low (A), intermediate (B), and high (C) dose groups, to study the potential differences in outcome between the different dose prescriptions. Cohort:n= 184. Median age: 69 years. Male:n= 105 (57%), female:n= 79 (43%). Stage IV:n= 117 (64%). T4:n= 127 (69%). Tumor location: head:n= 109 (59%), body:n= 37 (20%), tail:n= 25 (14%), neck:n= 11 (6%), and uncinate:n= 2 (1%). Prior systemic therapy:n= 66 (36%). Most common dose fractionations received: 20 Gy in five fractionsn= 67 (36%), 30 Gy in 10 fractionsn= 49 (27%), and 8 Gy in one fractionn= 23 (13%). Group A:n= 33 (18%), median overall survival (OS) 19 days (95% CI 4–33). Group B:n= 84 (46%), median OS 52 days (95% CI 43–60). Group C:n= 67 (36%), median OS 126 days (95% CI 77–174). Median days to in-field progression: Group A 59 days (range 7–109), Group B 96 days (range 19–173), and Group C 97 days (range 13–475). To our knowledge, this is the largest reported retrospective cohort of patients receiving non-ablative palliative RT to treat their primary pancreatic tumors. Most patients had metastatic disease, T4 tumors of the pancreatic head and had not received prior systemic therapy. A significant survival benefit was seen favoring the high dose/longer RT fractionation group, presumably due to appropriate patient selection rather than an RT effect. Despite the relatively short median overall survival, one fifth of the patients were found to experience an in-field progression following RT.
本研究探讨了姑息性放疗在原发性、不可治愈的局部晚期胰腺癌患者中的应用情况。这类患者生存期极短，临床采用多种姑息放疗剂量分割方案，但由于缺乏统一指南，实际治疗模式存在差异，剂量选择主要依赖医师经验。我们根据患者接受的剂量分割方案将其分为三组：低剂量组（A）、中剂量组（B）和高剂量组（C），以探究不同剂量处方对治疗结局的潜在影响。 研究队列共184例患者，中位年龄69岁。男性105例（57%），女性79例（43%）。IV期患者117例（64%），T4期127例（69%）。肿瘤部位分布：胰头109例（59%），胰体37例（20%），胰尾25例（14%），胰颈11例（6%），钩突2例（1%）。既往接受过全身治疗者66例（36%）。最常见的剂量分割方案：5次20 Gy（67例，36%）、10次30 Gy（49例，27%）和单次8 Gy（23例，13%）。 A组33例（18%），中位总生存期19天（95% CI 4-33）；B组84例（46%），中位总生存期52天（95% CI 43-60）；C组67例（36%），中位总生存期126天（95% CI 77-174）。放疗野内进展中位时间：A组59天（范围7-109），B组96天（范围19-173），C组97天（范围13-475）。 据我们所知，这是目前报道的最大规模接受非消融性姑息放疗治疗原发性胰腺肿瘤的回顾性队列研究。多数患者存在转移性病变、胰头T4期肿瘤且未接受过全身治疗。研究显示高剂量/较长放疗分割组具有显著生存获益，推测主要源于合适的患者选择而非放疗本身作用。尽管中位总生存期相对较短，仍有约五分之一患者在放疗后出现放疗野内进展。
肿瘤(癌症)患者之家