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目的观察三维适形放疗(3DCRT)联合卡培他滨治疗局部晚期胰腺癌的疗效和毒性反应。方法 37例局部晚期胰腺癌患者随机分为3DCRT联合卡培他滨组(实验组)18例和单纯3DCRT组(对照组)l9例,实验组接受三维适形放疗,总量50.4～54.0 Gy,1.8～2.0 Gy/次,5次/周,同时口服卡培他滨850 mg/m2,2次/d,周一至周五与放疗同步;对照组只接受三维适形放疗。放疗结束后停止2～3周后,两组均开始用吉西他滨1000 mg/m2第1、8天,每3周为1个疗程,共4疗程。观察两组近期疗效、1年生存率、临床受益反应和毒性反应。结果实验组完全缓解率1/18(5.5%),部分缓解率7/18(38.9%),总有效率44.4%;对照组完全缓解率1/19(5.3%),部分缓解率6/19(31.5%),总有效率36.8%,两组间差异无统计学意义(P>0.05)。实验组和对照组1年生存率分别为61.1%和47.4%(P>0.05)。中位生存期实验组较对照组延长1月,分别为12月(CI:10.34～13.66)和11月(CI:8.16～13.84)。实验组疼痛评分降低优于对照组(P<0.05);体重增加和Karnofsky评分升高实验组与对照组无差异(P>0.05)。两组血液毒性、胃肠道反应等发生率无差异(P>0.05),但实验组手足综合征的发生率较对照组高(P<0.01)。结论三维适形放疗联合卡培他滨治疗局部晚期胰腺癌,与单纯三维适形放疗相比,能明显改善患者的生活质量,不良反应可耐受,近期疗效和1年生存率无显著差异。
Objective To observe the efficacy and toxicity of three-dimensional conformal radiotherapy (3DCRT) plus capecitabine in the treatment of locally advanced pancreatic cancer. Methods Thirty-seven patients with locally advanced pancreatic cancer were randomly divided into three groups: 18 cases of 3DCRT combined with capecitabine group (experimental group) and 19 cases of simple 3DCRT group (control group). The experimental group received three-dimensional conformal radiotherapy with a total volume of 50.4-54.0 Gy, 1.8-2.0 Gy / time, 5 times / week, while oral capecitabine 850 mg / m2, 2 times / d, Monday to Friday synchronized with radiotherapy; the control group received only three-dimensional conformal radiotherapy. After 2 to 3 weeks after the end of radiotherapy, both groups started gemcitabine 1000 mg / m2 on days 1 and 8, every 3 weeks for a course of treatment, a total of 4 courses. The two groups were observed the short-term efficacy, 1-year survival rate, clinical benefit response and toxicity. Results In the experimental group, the complete remission rate was 1/18 (5.5%), partial remission rate was 7/18 (38.9%), and the total effective rate was 44.4%. The complete remission rate was 1/19 (5.3%) in the experimental group and the partial remission rate was 6/19 (31.5%), the total effective rate was 36.8%. There was no significant difference between the two groups (P> 0.05). The 1-year survival rates of experimental group and control group were 61.1% and 47.4%, respectively (P> 0.05). The median survival time was prolonged in January compared with the control group, which was December (CI: 10.34 ~ 13.66) and November (CI: 8.16 ~ 13.84), respectively. The pain scores in the experimental group were significantly lower than those in the control group (P <0.05). The body weight gain and Karnofsky score increased in experimental group and control group (P> 0.05). There was no difference in the incidence of hematological toxicity and gastrointestinal reaction among the two groups (P> 0.05), but the incidence of hand-foot syndrome in the experimental group was higher than that in the control group (P <0.01). Conclusion Three-dimensional conformal radiotherapy combined with capecitabine in the treatment of locally advanced pancreatic cancer, compared with simple three-dimensional conformal radiotherapy, can significantly improve the patient’s quality of life, adverse reactions can be tolerated, the short-term efficacy and 1-year survival rate was no significant difference.