【摘要】 目的　分析体外放射治疗在晚期胰腺癌治疗中的作用。方法　回顾性分析 1991年～ 1998年收治的 77例胰腺癌。TNM分期 :Ⅱ期 19例、Ⅲ期 2 8例、Ⅳ期 30例。行Whipple术 +术后外放射 2例 ,剖腹探查 +引流术 45例 ,未手术者 30例。 77例中接受外放射 2 1例 (肿瘤量 9.5～ 6 2 .6Gy ,45Gy以上 12例 ;合并化疗 11例 ) ;非放射组化疗 14例 ,中药及免疫治疗 33例 ,9例术后未行其它治疗。结果　本组病例中位生存期为 15个月 ,1、3年生存率分别为 40 %和 12 %。外放疗组中位生存期 2 1个月 ,1、3年生存率分别为 6 4%和 2 3 % ;非放疗组中位生存期 10 .5个月 ,仅 1例生存 13个月 ,放疗组生存率明显提高 (P <0 .0 5 )。放疗组腹痛、腰背痛减轻率 90 % ;非放疗组疼痛减轻率 6 %。 17例黄疸患者未手术 ,其中 5例行放疗 ,黄疸减轻 3例 ;12例未放疗 ,黄疸均加重。放疗剂量大于 45Gy组 ,中位生存期 2 7个月 ,1、3年生存率分别为 6 5 %和 2 6 % ;小于 45Gy组 ,中位生存期仅 12月 ,1、3年生存率分别为 43 %和 17% ,P <0 .0 5。Cox多因素分析显示 :手术、放射治疗、放疗剂量、分期和年龄与胰腺癌的预后有显著性差异(P <0 .0 5 ) ;而全身化疗、中药及免疫治疗对生存率无显著影响。结论　外放射是影响胰腺癌预后的重要因素之?更多还原

【Abstract】 Objective To investigate the effect of external-beam radiation therapy(EBRT) on the advanced pancreatic cancer.Methods 77 cases of pancreatic cancer were treated in 1991～1998.TNM staging:stage Ⅱ 9 cases,stage Ⅲ 28,stage Ⅳ 30.Two patients had Whipple′s resection and postoperative radiation.45 patients received exploration and/or palliative bypass with biopsy alone,30 cases didn′t receive surgery.21 of 77 patients received EBRT(9.5～62.6 Gy/5～35Fx/7～46 ds,>45 Gy 12 cases).25 patients received chemotherapy(The dominant drug was 5-Fu,11 cases received EBRT+chemotherapy).Results The total median survival was 15 months,1,3 year survival rate were 40% and 12%,respectively.In EBRT group,the median survival time was 21 months;1,3 year survival rate were 64% and 23%,one patient survived over 5 years;The abdominal pain relief rate was 90%.In non-EBRT group,the median survival was 10.5 months,only one case survived over one year(13 months);the pain relief rate was 6%,and 55% cases had aggressive abdominal pain.Among 17 patients with jaundice who didn′t receive operation,3 of 5 patients who received EBRT had jaundice relief,12 patients without EBRT all became worse.The median survival and 1,3 year survival rate for patients with radiation dose over 45 Gy(27 ms,65%,26%) were higher than that with dose below 45 Gy(12 ms,43%,17%).COX regression analysis showed:surgery,EBRT,radiation dose,TNM staging and age had significant effect on the survival rate of pancreatic cancer;Chemotherapy,chinese herbs and immune therapy had no significant effect.Conclusion EBRT can relieve symptoms and prompt survival quality in advanced pancreatic cancer.EBRT with dose over 45 Gy can increase the survival rate and prolong the survival time.更多还原