本文選題：胰腺腫瘤 + 術(shù)中電子線放射療法��； 參考：《北京協(xié)和醫(yī)學(xué)院》2017年碩士論文

【摘要】：第一部分術(shù)中電子線放療在不可切除局部晚期胰腺癌治療中的作用目的利用術(shù)中電子線放療(IOERT)精準(zhǔn)照射腫瘤和保護(hù)正常組織及單次高劑量的優(yōu)勢(shì),探索單純術(shù)中放療在不可切除局部晚期胰腺癌治療中的作用。方法從2009年1月至2014年12月,共82例患者在本院僅行IOERT,因術(shù)中探查為不可切除的T3-4M0胰腺癌。IOERT劑量10-20Gy,中位劑量15Gy。按IOERT的劑量分為15Gy、15Gy和15Gy三組,分析其總生存(OS)、無(wú)進(jìn)展生存(PFS)和腫瘤特異性生存、毒副反應(yīng)。除高劑量(15Gy)組的KPS評(píng)分較高(P=0.003),腫瘤較小(P0.001)外,其它臨床資料可比。結(jié)果生存患者中位隨訪時(shí)間423天。在單純行術(shù)中放療的82例患者中,中位OS期為8.1個(gè)月,1年OS率為40.4%;中位PFS 5.2個(gè)月,1年P(guān)FS率為26.8%;中位CSS期8.1個(gè)月,1年CSS率為42.6%。在IOERT劑量為15Gy、15Gy和15Gy三組中,其中位OS及1年OS率分別為6.2個(gè)月和10.0%、9.1個(gè)月和39.6%、22.2個(gè)月和77.4%(P0.001),顯示IOERT劑量越高,生存越好。發(fā)生≥3級(jí)的重度胃腸道(2.4%)、腹痛(4.9%)、骨髓抑制(3.7%)毒副反應(yīng)均在可耐受范圍內(nèi),三組之間無(wú)統(tǒng)計(jì)學(xué)差異。單因素分析:IOERT劑量、腫瘤大小、年齡和KPS評(píng)分為影響預(yù)后因素(P0.001、0.033、0.040、0.023)。多因素分析示IOERT劑量為獨(dú)立預(yù)后因素(P=0.001)。結(jié)論在局部晚期不可切除胰腺癌中,給予IOERT是安全有效的治療手段;多因素分析IOERT劑量為獨(dú)立預(yù)后因素。在治療耐受性好或腫瘤較小,以及胃腸道不在照射范圍內(nèi)時(shí),可適當(dāng)增加IOERT劑量從而提高療效。第二部分術(shù)中放療聯(lián)合術(shù)后放化療在不可切除局部晚期胰腺癌中的療效目的分析總結(jié)術(shù)中放療聯(lián)合體外放療或同步放化療的療效和毒副反應(yīng),尋找提高術(shù)中不能切除胰腺癌的治療方法。方法從2009年1月至2014年12月,65例術(shù)中探查為不可切除的T3-4M0胰腺癌,在本院行IOERT和術(shù)后聯(lián)合EBRT或CCRT。IOERT劑量為10-15Gy,術(shù)后EBRT劑量為30-46Gy,同步化療方案主要是吉西他濱300mg/m2每周方案。65例患者中12例IOERT+EBRT,另53例給予IOERT+CCRT的治療,兩組臨床資料可比。分析兩組之間的OS、PFS、不良反應(yīng)等指標(biāo)。結(jié)果生存患者中位隨訪時(shí)間772天。聯(lián)合術(shù)后體外照射和聯(lián)合術(shù)后同步放化療兩組的中位OS期及3年OS率分別為8.7個(gè)月和0.0%、11.6個(gè)月和11.3%(P=0.042)。其腫瘤特異性生存時(shí)間及3年的腫瘤特異性生存率分別為8.7個(gè)月、0.0%和11.8個(gè)月、11.5%(P=0.038)。兩組的中位局部控制時(shí)間分別為7.9個(gè)月和9.6個(gè)月,1年的局部控制率分別為16.7%和34.0%(P=0.282)。中位遠(yuǎn)處轉(zhuǎn)移控制時(shí)間為6.6個(gè)月和9.4個(gè)月,1年遠(yuǎn)轉(zhuǎn)控制率為25.0%和37.7%(P=0.381)。兩組發(fā)生≥3級(jí)的重度胃腸道、腹痛、骨髓抑制毒副反應(yīng)均無(wú)統(tǒng)計(jì)學(xué)差異。單因素分析僅術(shù)后聯(lián)合CCRT(P=O.042)為預(yù)后良好因素。結(jié)論相比IOERT聯(lián)合EBRT,IOERT聯(lián)合CCRT可延長(zhǎng)局部晚期不可切除胰腺癌生存,延遲局部和遠(yuǎn)處轉(zhuǎn)移時(shí)間,且重度毒副反應(yīng)在可耐受范圍內(nèi)。第三部分術(shù)中放療聯(lián)合不同輔助治療在不可切除局部晚期胰腺癌中的作用目的局部晚期胰腺癌推薦綜合治療。本研究比較IOERT及聯(lián)合術(shù)后不同輔助治療的生存、復(fù)發(fā)和治療相關(guān)毒副反應(yīng)情況,了解IOERT聯(lián)合不同輔助治療的價(jià)值和意義。方法從2009年1月至2014年12月,因術(shù)中探查不可切除的T3-4M0胰腺癌給予IOERT。IOERT劑量為10-15Gy。在79例術(shù)后聯(lián)合不同輔助治療方案中,12例IOERT+EBRT,53例IOERT+CCRT,14例給予IOERT+化療(術(shù)中放療聯(lián)合化療)。EBRT劑量為30-46Gy,同步化療方案主要為吉西他濱300mg/m2每周方案。輔助化療多樣,其中以單藥吉西他濱、吉西他濱聯(lián)合卡培他濱化療方案為主。結(jié)果生存患者中位隨訪時(shí)間748天。IOERT+EBRT、IOERT+CCRT和IOERT+化療三組的中位OS期及2年OS率分別為8.7個(gè)月和0.0%、11.6個(gè)月和26.2%、11.5個(gè)月和11.4%(P=0.112)。僅比較IOERT+化療和IOERT+CCRT之間的OS也無(wú)統(tǒng)計(jì)學(xué)差異(P=0.413)。兩組的局部控制時(shí)間(6.8個(gè)月vs.9.6個(gè)月,P=0.577)和遠(yuǎn)轉(zhuǎn)控制時(shí)間(7.2個(gè)月vs.9.4個(gè)月,P=0.699)雖無(wú)統(tǒng)計(jì)學(xué)差別,但顯示同步放化療組有更好的趨勢(shì)。結(jié)論IOERT聯(lián)合術(shù)后CCRT與IOERT聯(lián)合化療生存無(wú)統(tǒng)計(jì)學(xué)差異,中位生存期均可達(dá)到11.6個(gè)月;顯示IOERT+CCRT不僅是安全可行的有效治療方案,且療效不差于化療。
[Abstract]:Part 1 the role of electron beam radiotherapy in the treatment of unresectable locally advanced pancreatic cancer objective to explore the role of intraoperative radiotherapy (IOERT) for accurate irradiation of tumors, to protect normal tissues and to a single high dose, and to explore the role of intraoperative radiotherapy in the treatment of locally advanced locally advanced pancreatic adenocarcinoma. Methods from January 2009 to 201 In December 4 years, a total of 82 patients were treated with only IOERT in our hospital. The dose of.IOERT was 10-20Gy for the non resectable pancreatic cancer. The median dose 15Gy. was divided into 15Gy, 15Gy and 15Gy three groups according to the IOERT dose, and the total survival (PFS) and tumor specific survival and side effects were analyzed. 0.003), the tumor was smaller (P0.001), other clinical data were comparable. Results the median follow-up time of the survival patients was 423 days. The median OS period was 8.1 months and the 1 year OS rate was 40.4%; the median PFS 5.2 months, the 1 year PFS rate was 26.8%; the median CSS period was 8.1 months, and the CSS rate of the 1 year was 15Gy, 15Gy, and 15Gy three at 42.6%.. In the group, the OS and 1 year OS rates were 6.2 months and 10%, 9.1 months and 39.6%, 22.2 months and 77.4% (P0.001), which showed that the higher the IOERT dose, the better the survival. The severe gastrointestinal tract (2.4%), abdominal pain (4.9%), and the myelosuppression (3.7%) side reaction were all tolerable, and there was no statistical difference between the three groups. The single factor analysis: IOERT Dose, tumor size, age and KPS score were associated with prognostic factors (P0.001,0.033,0.040,0.023). Multivariate analysis showed that IOERT dose was an independent prognostic factor (P=0.001). Conclusion IOERT is a safe and effective treatment in locally advanced non resectable pancreatic cancer; multifactor analysis of IOERT dose is an independent prognostic factor. The effect of intraoperative radiotherapy combined with radiotherapy and chemoradiotherapy on unresectable locally advanced pancreatic cancer is analyzed and the efficacy and side effects of intraoperative radiotherapy combined with extracorporeal radiotherapy or concurrent chemoradiotherapy in the second part of the operation are analyzed. The results of the second part of the radiotherapy combined with radiotherapy and chemotherapy in the unresectable locally advanced pancreatic cancer. Methods to improve the treatment of unresectable pancreatic cancer during the operation. Methods from January 2009 to December 2014, 65 cases of unresectable T3-4M0 pancreatic cancer were explored. In our hospital, the dosage of IOERT and postoperative combined EBRT or CCRT.IOERT was 10-15Gy, the EBRT dose was 30-46Gy after operation, and the synchronous chemotherapy scheme was mainly the.65 case of gemcitabine 300mg/m2 weekly program. Of the 12 cases of IOERT+EBRT, the other 53 cases were treated with IOERT+CCRT, two groups of clinical data were comparable. The OS, PFS, and adverse reactions between the two groups were analyzed. The median follow-up time of the survival patients was 772 days. The median OS stage and the 3 year OS rate of the two groups after combined operation and postoperative combined radiotherapy and radiotherapy were 8.7 months and 0%, 11.6 months and 11.6 months, respectively. 11.3% (P=0.042). The tumor specific survival time and the 3 year tumor specific survival rate were 8.7 months, 0% and 11.8 months, 11.5% (P=0.038). The median local control time of the two group was 7.9 months and 9.6 months respectively. The local control rate of 1 years was 16.7% and 34% (P=0.282) respectively. The median distant metastasis control time was 6.6 months and 9.4. 1 years of 1 years of remote control rate was 25% and 37.7% (P=0.381). There was no significant difference in severe gastrointestinal tract, abdominal pain, and myelosuppression side effects in group two. Single factor analysis only combined with CCRT (P=O.042) as a good prognostic factor. Conclusion compared with IOERT combined with EBRT, IOERT combined with CCRT can prolong the survival of locally advanced non resectable pancreatic cancer. Delayed local and distant metastasis and severe toxic and side effects within tolerable range. Third part of the role of intraoperative radiotherapy combined with different adjuvant therapy in unresectable locally advanced pancreatic cancer recommended comprehensive treatment for locally advanced pancreatic cancer. This study compared the survival, recurrence and treatment of IOERT and combined postoperative adjuvant therapy. The value and significance of IOERT combined with different adjuvant therapy were observed. Methods from January 2009 to December 2014, IOERT.IOERT dose of IOERT.IOERT was given to T3-4M0 for non resectable pancreatic cancer from January 2009 to December 2014. 12 cases of IOERT+EBRT, 53 cases of IOERT+CCRT, and 14 cases were given IOERT+ chemotherapy. The.EBRT dose of intraoperative radiotherapy combined with chemotherapy was 30-46Gy, and the synchronous chemotherapy regimen was mainly gemcitabine 300mg/m2 weekly. The adjuvant chemotherapy was varied, among which the single drug gemcitabine, gemcitabine combined with capecitabine were the main chemotherapy regimens. The median follow-up time of survival patients was 748 days.IOERT+EBRT, IOERT+CCRT and IOERT+ chemotherapy in the middle OS. The OS rate in the period and 2 years was 8.7 months and 0%, 11.6 months and 26.2%, 11.5 months and 11.4% (P=0.112). There was no statistical difference between IOERT+ chemotherapy and IOERT+CCRT (P=0.413). The local control time (6.8 months vs.9.6 months, P=0.577) and remote control time (7.2 months vs.9.4 months, P=0.699) in the two group were not statistically different, but there was no statistical difference. It showed that there was a better trend in the concurrent chemoradiotherapy group. Conclusion there was no statistical difference between CCRT and IOERT after IOERT combined with chemotherapy, and the median survival time could reach 11.6 months. It showed that IOERT+CCRT was not only a safe and effective treatment scheme, but also the curative effect was not worse than chemotherapy.

【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R735.9

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3 劉洋;I~(125)放射性粒子植入術(shù)對(duì)晚期胰腺癌的姑息治療：植入計(jì)劃的輔助三維模型設(shè)計(jì)及植入方法的研究[D];中國(guó)人民解放軍醫(yī)學(xué)院;2014年

4 張瑋;全身麻醉下低功率長(zhǎng)時(shí)間熱量累積高強(qiáng)度聚焦超聲治療晚期胰腺癌臨床觀察[D];浙江大學(xué);2013年

5 陳顥;循環(huán)DNA和k-ras基因突變對(duì)晚期胰腺癌診斷及中西醫(yī)綜合治療預(yù)后影響的研究[D];復(fù)旦大學(xué);2009年

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9 徐勇;Wnt2信號(hào)通路在胰腺癌轉(zhuǎn)移及侵襲中的作用[D];天津醫(yī)科大學(xué);2014年

10 高松;IGFBP2調(diào)節(jié)胰腺癌轉(zhuǎn)移及侵襲的機(jī)制及其臨床意義[D];天津醫(yī)科大學(xué);2015年

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