848 2016 10 1 41 10 95 - [ ] 95 (n=45) (n=50) 3 4~6(PFS) (OS)75.6% 86.0%(P 0.05) 94.7% 95.2% (P 0.05) CA19-9(P 0.01) (P 0.05) 20 PFS 10.1 11.2 OS 15.5 16.7 (P 0.05) 48.9% 56.0% 11.1% 20.0% (P 0.05) 3 4 PFS OS [ ] [ ] R735.9 [ ] A [ ] 0577-7402(2016)10-0848-05 [DOI] 10.11855/j.issn.0577-7402.2016.10.11 Clinical observation of cyberknife therapy combined with TS-1 in treatment of local advanced pancreatic cancer ZHANG Xin-hong, KANG Jing-bo, NIE Qing, XU Yun-ke, YAN Xiao-mei, ZHANG Jia-yue, ZHAN Xiao-yu Department of Radiotherapy Oncology and Integrative Oncology, Navy General Hospital of PLA, Beijing 100048, China [Abstract] Objective To evaluate the effect and toxicity of cyberknife therapy combined with titanium silicalite-1 (TS-1) in treatment of local advanced pancreatic cancer (LAPC). Methods Ninety-five patients with LAPC were divided into two groups: cyberknife group (control group, n=45) received cyberknife therapy only, and combination group (n=50) received cyberknife therapy combined with TS-1. The adjuvant chemotherapy was performed 3 weeks after radiotherapy, and lasted for 4-6 cycles continuously. The effect, side effect, progression-free survival (PFS) and overall survival (OS) were recorded. Results In cyberknife group and combination group, the objective response rates (ORR, CR+PR) were 75.6% and 86.0% (P<0.05) respectively, the pain relief rates were 94.7% and 95.2% (P>0.05) respectively. The indexes of total bilirubin and CA19-9 were significantly improved in the both groups after than before treatment with statistical significance (P<0.01), but there was no significant difference between the two groups (P>0.05). In the median follow-up time of 20 months, the median PFS was 10.1 and 11.2 months and the median OS was 15.5 and 16.7 months in cyberknife and combination group, respectively (P>0.05). The incidences of digestive tract adverse reaction and myelosuppression in cyberknife group and combination group were 48.9% and 56.0%, 11.1% and 20.0%, respectively (P>0.05). There was no grade 3-4 serious adverse reaction. Conclusion Cyberknife combined with TS-1 is effective and safe for patients with LAPC, may improve local control rate, effective rate, PFS and OS. [Key words] pancreatic neoplasm; cyber knife; TS-1 [1] 2% 10 20 4 7.28/10 [ ] [ ] 100048 ( ) 10%~15% 6 5 5% [2] [3-4] 2013 7 2015 5 95
Med J Chin PLA, Vol. 41, No. 10, October 1, 2016 849 1 1.1 2013 7 2015 5 95 PET/CT (CA19-9 ) [5] (KPS) 70 56 39 38~90 65 50 28 12 5 80 74 48 29 8 ( 6 4 ) CA19-9 87 91.6% 95 (n=45) (n=50) 1 1 95 [n(%)] Tab. 1 Clinical characteristics of the 95 patients with locally advanced pancreatic cancer [n(%)] Item Gender Cyberknife radiosurgery (n=45) Combined therapy (n=50) Male 27(60) 29(58) Female 18(40) 21(42) Age (year) 70 28(62.2) 35(70) 70 17(37.8) 15(30) KPS score Stage 80 12(26.7) 12(24) 80 33(73.3) 38(76) A 28(62.2) 30(60) B 17(37.8) 20(40) Position Pancreas head 25(55.6) 25(50) Pancreatic body tail 20(44.4) 25(50) CA19-9 Normal 4(8.9) 4(8) Abnormal 41(91.1) 46(92) Symptom Abdominal pain 38(84.4) 42(84) Jaundice 14(31.1) 15(30) Anorexia 36(80.0) 38(76) Combined therapy comprises cyberknife radiosurgery and TS-1 1.2 1. 2. 1 SR S ( Acc uray ) X 1mm 6MV 6 CT 1.5mm CT (gross tumor volume GT V ) PET/CT MRI GTV 5~8mm (planning target volume PTV) 95%PTV (30~45Gy) 4~7 65%~84% 2 0.5~1.0h 2 95 Tab. 2 Parameters of Cyberknife treatment for 95 patients with pancreatic cancer Parameters Range (x±s) Gross tumor volume (ml) 10-222.68(50.66 41) Dose (Gy) 30-45(35.98 3.23) Isodose curve (%) 65-84(78.78 4.06) Fraction (f ) 4-7(5.95 0.55) BED (Gy, / =10) 42-65.63(50.53 4.38) GTV coverage rate (%) 91.34-100(96.92 2.80) Conformal index 1.05-1.34(1.16 0.07) New conformal index 1.02-1.39(1.2 0.07) Homogeneity index 1.19-1.28(1.24 0.04) Beam 89-176(127.59 19.88) 1.2.2 40mg 2 /d 1~14d 21d 3 4~6 CA19-9 CT 1.3 (visual analogue scale/score VAS) VAS 3 [6]
850 2016 10 1 41 10 CT MRI PET/ CT 3 2 CT WHO (CR) (PR) (SD) (PD) CR+PR (ORR) RTOG 1~4 2015 12 (PFS) (OS) 1.4 SPSS 16.0 (%) χ 2 x±s t (OS) Kaplan-Meier Log-rank P 0.05 2 2.1 81.3% 75.6%(34/45) 86.0%(43/50) (P 0.05) 80 68 (85.0%) 8 (10.0%) 3~7d 4d 4 (5%) 94.7%(36/38) 95.2%(40/42) (P 0.05) CA19-9 (P 0.01) (P 0.05 3) 3 CA19-9 (x±s) Tab. 3 Comparison of the levels of TBIL and CA19-9 between Cyberknife and combination group (x±s) Index Total bilirubin ( mol/l) Cyberknife radiosurgery (n=45) Combined therapy (n=50) Pre-treatment 241.2 95.1 218.3 107.5 Post-treatment 46.3 39.2 (1) 41.7 30.1 (1) CA19-9 (U/ml) Pre-treatment 276.2 148.5 259.7 141.6 Post-treatment 50.6 34.6 (1) 55.6 37.9 (1) TBIL. Total bilirubin. (1)P<0.01 compared with post-treatment 2.2 1 2 3 11.1% 20.0% (P=0.102) 48.9% 56.0% (P=0.192) 2. 3 2015 12 8~30 20 (PFS) 10.1 11.2 (P 0.05) (OS) 15.5 16.7 (P 0.05) 1 55.6% 60.0%(P 0.05) 3 50%~60% [7-9] X 1mm 12~15Gy 3~6 45Gy ( / =10) 80~120Gy [10] 32 74.2% 1 53.1% [11] 75% 1 2 40% 20% [12] 5-FU 5-FU 1 (5.6 vs 4.4 ) [13] 5-FU [14] 5-FU
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