摘要目的 探讨立体定向放疗治疗胰腺转移癌的疗效.方法 对2006年1月至2014年12月解放军空军总医院放疗科收治的17例胰腺转移癌患者资料进行回顾性分析,其中胰腺转移癌的原发灶为肺癌7例,胆囊癌3例,食管癌、胃癌、肾癌、结肠癌、急性粒细胞白血病、左胸壁纤维组织细胞瘤、上肢滑膜肉瘤各1例.8例患者接受体部y刀治疗,5例接受调强放疗(IMRT),3例接受三维适形放疗(3DCRT),1例接受螺旋断层调强放疗(TOMO).转移癌最大径中位值3.6 cm(1.6～7.0 cm),大体肿瘤体积(GTV)中位值37.1 cm3(11.1 ～ 72.1 cm3),靶体积剂量中位值50 Gy(40～70 Gy).患者治疗时间为14～22 d,1次/d,5次/周,放疗单次剂量中位值3Gy.结果 近期疗效达到完全缓解(CR)4例,部分缓解(PR)8例,稳定(SD)2例,治疗总有效率为70.1％(12/17).9例腹痛,止痛治疗达到CR 3例,PR 5例,轻微缓解(MR)1例.患者6个月、1年的局部控制率均为100％,1、2年总生存率分别为35.3％、5.9％.全组患者均无3级以上急性、晚期放射反应.结论 大多数胰腺转移癌患者已失去手术机会,立体定向放疗可改善患者生命质量,局控率高,且不良反应小,可耐受.

abstractsObjective To discuss the clinical value of stereotactic radiotherapy for the treatment of metastatic pancreatic cancer.Methods Data of 17 patients with metastatic pancreatic cancer were retrospectively studied.All patients were admitted to Air Force General Hospital from January 2006 to December 2014.Lung carcinoma was the most common primary tumor (n =7),followed by cystic carcinoma (n =3),esophageal cancer (n =1),gastric carcinoma (n =1),renal carcinoma (n =1),colon carcinoma (n =1),acute myeloid leukemia (n =1),left chest fibrous histiocytoma (n =1),and upper extremity synovial sarcoma (n =1).There were 8 patients choosing the therapy of body gamma knife,5 choosing the therapy of IMRT,3 choosing the therapy of 3DCRT and 1 choosing the therapy of TOMO.Metastases median maximum diameter was 3.6 cm (range,1.6-1.7 cm),median target volume was 37.1 mm3 (range,11.1-72.1 mm3) and median GTV dose was 50 Gy (range,40-70 Gy).Patients treatment time was 14 to 22 days,5 fractions/week and median single dose was 3 Gy.Results Of all the patients of this group,4 patients qualified as complete remission (CR),8 patients reached the standard of partial remission (PR),and 2 patients maintained the situation of stable disease (SD).The total percentage of therapeutic efficiency was 70.1％ (12/17).As for the analgesic therapy,3 patients qualified as CR,5 patients reached the standard of PR,and 1 patient maintained the situation of MR (minimal response).The total percentage of analgesic therapeutic efficiency was 100 ％.The local control rates for six-month and 1 year were both 100 ％,and the overall survival rates for 1 year and 2 years were 35.3 ％ and 5.9 ％.No Grade 3 or more acute and late radiation reaction was observed.Conclusion The majority of patients with pancreatic metastatic carcinoma have lost the opportunity to have surgery,but the stereotactic radiation therapy can improve the quality of life and local control rate with small toxicity and acceptable complications.