消融立体定向放射治疗不能手术的非转移性胰腺癌的长期疗效。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2025-10-17 DOI:10.1016/j.radonc.2025.111210

Bi-Yang Cao , Le-Tian Zhang , Chen-Chen Wu , Jing Wang

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引用次数: 0

摘要

目的/目的：评估在不能手术的非转移性胰腺癌（PC）患者中，给予生物有效剂量（BED10, α/β = 10） ≥ 100 Gy的消融5段立体定向放射治疗（SBRT）的长期预后和耐受性。材料/方法：我们回顾性回顾了2016年至2020年期间88例不可手术的非转移性PC患者，这些患者使用基于基准呼吸跟踪的射波刀进行了消融5-分数SBRT。结果包括总生存期（OS）、无进展生存期（PFS）和治疗相关毒性。结果：该队列包括55名男性和33名女性（中位年龄65 岁；范围36-84 岁）。诊断时，29例患者医学上无法手术，59例为局部晚期PC （LAPC）。82例患者给予50 Gy/5分数的SBRT， 6例患者给予55 Gy/5分数的SBRT。肿瘤总体积中位数为33.6  cm3（范围3.7-167.8）。中位随访时间为64.0 个月，自诊断时起的中位OS （mOS）为18.1 个月（95 %置信区间[CI]， 16.6-27.1），自SBRT开始的中位OS （mOS）为15.6个月（95 % CI, 14.1-23.4）。诊断后的1年、2年和3年OS率分别为73.9 %、39.8 %和26.1 %，SBRT后的OS率分别为64.0 %、36.0 %和22.1 %。在诊断的mOS 18.2个月(95 % CI, 17.0 - -37.1),临床上病人和 17.1个月(95 % CI, 15.9 - -28.9)对于那些LAPC,与相应的1 - 2,和3年OS 86.2 %, % 41.4和31.0 % 67.8 vs %,39.0 %,分别和23.7 %。SBRT从一开始,相应的金属氧化物半导体 16.2个月(95 % CI, 15.0 - -35.9),临床上病人和 14.4个月(95 % CI, 11.0 - -23.7) LAPC,与1 - 2,和3年OS 75.9 %, % 37.9和27.6 %与57.6 % 33.9 %,分别和18.6 %。4例患者发生3级消化道出血（4.5 %），未观察到 ≥ 4级毒性反应。结论：在不能手术的、非转移性的PC中，经5段烧割性SBRT治疗BED10 ≥ 100  Gy可获得良好的生存期和可接受的毒性。

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Long-Term outcomes of ablative stereotactic body radiation therapy for inoperable, non-metastatic pancreatic cancer

Purpose/Objective(s)

To evaluate long-term outcomes and tolerability of ablative 5-fraction stereotactic body radiation therapy (SBRT) administering a biologically effective dose (BED₁₀, α/β = 10) ≥ 100 Gy in patients with inoperable, non-metastatic pancreatic cancer (PC).

Materials/Methods

We retrospectively reviewed a prospective registry of 88 patients with inoperable non-metastatic PC who underwent ablative 5-fraction SBRT using a CyberKnife with fiducial-based respiratory tracking between 2016 and 2020. The outcomes included overall survival (OS), progression-free survival (PFS), and treatment-related toxicity.

Results

The cohort included 55 men and 33 women (median age, 65 years; range, 36–84 years). At diagnosis, 29 patients were medically inoperable, and 59 had locally advanced PC (LAPC). SBRT was administered at 50 Gy/5 fractions in 82 patients and 55 Gy/5 fractions in 6 patients. The median gross tumor volume was 33.6 cm³ (range, 3.7–167.8). With a median follow-up of 64.0 months, the median OS (mOS) was 18.1 months (95 % confidence interval [CI], 16.6–27.1) from the time at diagnosis and 15.6 months (95 % CI, 14.1–23.4) from the start of SBRT. The 1-, 2-, and 3-year OS rates were 73.9 %, 39.8 %, and 26.1 % from diagnosis, and 64.0 %, 36.0 %, and 22.1 % from SBRT, respectively. The mOS from the time at diagnosis was 18.2 months (95 % CI, 17.0–37.1) for medically inoperable patients and 17.1 months (95 % CI, 15.9–28.9) for those with LAPC, with corresponding 1-, 2-, and 3-year OS rates of 86.2 %, 41.4 %, and 31.0 % vs. 67.8 %, 39.0 %, and 23.7 %, respectively. From the start of SBRT, corresponding mOS was 16.2 months (95 % CI, 15.0–35.9) for medically inoperable patients and 14.4 months (95 % CI, 11.0–23.7) for LAPC, with 1-, 2-, and 3-year OS rates of 75.9 %, 37.9 %, and 27.6 % vs. 57.6 %, 33.9 %, and 18.6 %, respectively. Grade 3 gastrointestinal bleeding occurred in four patients (4.5 %), with no grade ≥ 4 toxicities observed.

Conclusion

Ablative 5-fraction SBRT with BED₁₀ ≥ 100 Gy results in favorable survival and acceptable toxicity in inoperable, non-metastatic PC.

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.