Clinical observation of stereotactic radiotherapy combined with gemcitabine for pancreatic carcinoma

Objective To observe clinical therapeutic effect of stereotactic conformal radiotherapy(body gamma knife)combined with gemcitabine for patients with pancreatic carcinoma. Methods A total of 131 patients with advanced local pancreatic carcinoma were divided into two groups(group A,82 cases received radiotherapy alone;group B,49 cases got radiotherapy combined with gemcitabine).All of them(male 95,female 36,aged 23-82 years old,median age 71.8 years old) were treated by OUR-QGD type stereotactic radiotherapy gamma rays system: 50% dose curve overjetted 100% plan target volume(PTV),60% dose curve overjetted 90% clinical target volume(CTV),70% dose curve overjetted 80% grosses tumor volume(GTV).The prescription dose was according to 50% dose curve.Encircled dose of carcinoma which in the head of pancreas was 3-4Gy per fraction,in the body tail of the pancreas was 4-5Gy per fraction.The range of total dose was 32-50Gy,divided into 8-12 fractions.The concomitant chemotherapy started at the first day of radiotherapy: gemcitabine 0.5g/m2 intravenously injected within 30 minutes,d1,d8.That adjuvant chemotherapy was taken 3 weeks after radiotherapy: gemcitabine 1g/m2,VD,d1,d8,d15;28 days was a cycle.The chemotherapy lasted for 2-6 cycles continuously.The median time of follow-up was 17 months.Therapeutic effect,side effects,overall survival(OS) and progression-free survival(PFS) were recorded. Results In group A and B,the rate of the overall response(CR+PR) was 71.9% and 79.6%,the rate of pain remitting in epigastria and notum was 94.3% and 93.3%,respectively(P0.05).After treatment,the index of total bilirubin and CA199 were significantly improved in both two groups.The median PFS and OS between group A and B were 7.9 and 13.0 months,14.1 and 16.4 months,respectively.There were significant differences between group A and B in PFS(P0.05),but not in OS.Rate of the major toxicities occurring of group B in gastrointestinal tract reaction and hematology was higher than group A.No perforation,serious bleeding or continuous high fever has been observed.No treatment-related death occurred. Conclusion The stereotactic conformal radiotherapy for patients with pancreatic carcinoma can increase accurately localized high-dose radiation on tumor,and reduce the surrounding normal tissue damage.Stereotactic conformal radiotherapy combined with gemcitabine can significantly prolong PFS,but fail to improve OS,while increase part of toxicity.