目的 探讨螺旋断层放疗(TOMO)治疗不可切除胰腺癌的临床疗效和安全性.方法 回顾性分析本院2011年12月至2015年12月接受TOMO治疗的不可切除胰腺癌患者71例(病理确诊39例,临床诊断32例),治疗靶区共266个,其中原发灶71个、区域淋巴结56个、肝脏转移灶139个;胰腺病灶、肝脏转移灶及转移淋巴结的照射剂量(DT)依次为50～ 70 Gy、59.4～ 65 Gy和54～65 Gy;71例患者中同步化疗44例,辅助化疗25例.分别采用RECIST 1.1版与NCI-CTC 4.0版标准评价疗效和不良反应,Kaplan-Meier法进行生存分析,采用Cox风险比例回归模型分析影响预后的因素.结果 71例患者全部完成放疗计划.266个靶区的有效率和疾病控制率分别为61.7％和98.9％.单因素分析显示,临床分期、M分期、CA199水平、PS评分、同步化疗及辅助化疗与预后有关(P＜0.05);Cox多因素分析显示,M分期、PS评分、同步化疗、辅助化疗和CA199水平均为影响生存期(OS)的独立预后因素.治疗急性反应主要为1～2级乏力、消化道反应和骨髓抑制,经对症处理后均能耐受并完成治疗,无治疗相关性死亡和3～4级急性毒性反应.结论 TOMO治疗不可切除胰腺癌可提高患者生存率、改善生活质量,且患者耐受性良好.尤其对于合并肝转移甚至是多发转移的晚期患者,积极采用同步放化疗可取得较好疗效.%Objective To explore the feasibility and clinical outcome of tomotherapy (TOMO) in patients with advanced pancreatic cancer.Methods Seventy-one patients with advanced pancreatic cancer including primarily unresectable disease,metastasis disease and recurrence after curative surgery were included in the study.Thirty-nine cases were diagnosed by pathology and 32 cases of clinical diagnosis.A total of 266 target areas were treated including 71 cases of primary lesions,56 cases of regional lymph nodes and 139 cases of liver metastases.The total doses to gross volume were 50-70 Gy in pancreatic,54-65 Gy in lymph nodes and 59.4-65 Gy in metastasis liver.Forty-four patients received concurrent chemotherapy,and 25 patients received sequential chemotherapy.The efficacy and safety were evaluated by RECIST 1.1 and NCI-CTC 4.0 criteria.Overall survival (OS) was analyzed by Kaplan-Meier method.The factors affecting the prognosis were analyzed by Cox risk proportional regression model.Results All the 71 patients completed the radiotherapy plan.The response rate and disease control rate were 61.7％ and 98.9％ in 266 target areas,respectively.Univariate analysis showed that clinical stage,M stage,CA199 level,PS scores,concurrent chemotherapy and adjuvant chemotherapy were associated with prognosis (P ＜ 0.05).Multivariate analysis showed that M stage,PS scores,concurrent chemotherapy,adjuvant chemotherapy and CA199 were independent prognostic factors for OS.The main acute reactions were fatigue,digestive tract reaction and bone marrow suppression of grade 1-2.After symptomatic treatment,all patients were able to tolerate and complete treatment without treatment-related deaths and acute toxicity of grade 3-4.Conclusion TOMO with concurrent chemotherapy is a feasible option without significant toxicities for patients with advanced pancreatic cancer.Especially for patients with advanced liver metastasis or even multiple metastases,concurrent chemoradiotherapy is expected to achieve good results.
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