Clinical Study Of Pancreatic Tumor With Stereotactic Body Radiation Therapy

Part 1. Prognostic significance of PET/CT SUVmax in pancreatic tumor treated with γ-knife.ObjectiveTo discuss the correlation between SUVmax of PET/CT in patients with pancreatic tumor of body gamma knife radiotherapy effect.MethodsData of 51 cases of gamma knife treatment for pancreatic cancer were retrospectively studied. All patients were admitted to Air Force General Hospital from July 2010 to August 2014. All of the patients before radiotherapy 2 weeks underwent 18F-FDG PET/CT examination, and calculated the SUVmax. Patients were supine, fixed with a stereotactic body frame and vacuum bag. and then simulated by low-speed computed tomography. GTV, CTV and PTV were defined on the contrast-enhanced CT and PET/CT scans. It was required that 50% isodose line covered 100% of PTV and 70% isodose line covered more than 80% of GTV. The prescription dose was defined as 50% isodose. Irradiation of 30～60Gy was delivered to PTV margins. The fractionated dose was 2.5～4Gy.5 fractions per week. Early efficacy was evaluated after radiotherapy 3 months. The data were analyzed with SPSS17.0 statistical software.Using Kaplan-Meier method to calculate the survival rate, the Log-rank method by single factor analysis of gender, age. tumor location, KPS score, Cox model multivariate analysis of prognostic factors were needed for the significant single factor.Results1.Analgesic effect:The total effective rate of the pain treatment was 90.2%,including the complete remission rate (CR)23.5%, the partial remission (PR) rate 56.9%,MR9.8%. 2.The short-term curative effect rate and SUVmax:The complete remission(CR) rate,the partial remission(PR) rate,the lesions stable disease(SD) rate,the total effective rate was 21.6%,51%,13.7%,72.5%,repectively.3.Survival:the survival time of this group of 51 cases was 3 ～ 37 months, patients with stage Ⅱ Ⅰ,1-,2-,3- year survival rate were 66.7%,33%,13.3%, the median survival time was 12 months; patients with stage Ⅲ Ⅳ,1-,2-,3- year survival rate were 25%,11.1% and 0, the median survival time was 6 months;all of the patientsl-,2-,3-year overall survival rate were 37.3%,17.6%,3.9%,respectively, the median survival time was 7 months.4.Analysis of prognostic factors:single factor analysis showed that patients with liver metastasis (x2=15.543,p<0.001),TNM stage (x2=9.385,p=0.002),SUVmax value (x2=4.574, p=0.032), GTV (x2=4.492,p=0.038), radiotherapy dose (x2=4.161,p=0.045) is significant radiotherapy prognostic factors to affect the survival of pancreatic cancer patients, regardless of gender, age, tumor location, the degree of pain, the decrease degree of body weight before radiotheray. Multivariate analysis showed that the SUVmax values before radiotheray (p=0.016) is a prognostic factor to affect the survival in patients with pancreatic carcinoma after radiotherapy.5.Radioreaction:No Grade 3 or more and late radiation reaction was observed.6.Analysis of death causes:the whole group of 51 patients all died at the end of follow-up,including the 43 casesdied of the distant metastasis and multiple organ failure,4 cases died of gastrointestinal bleeding,3 cases died of massive hemoptysis.1 cases died of cerebral hemorrhage.ConclusionThe majority of patients with pancreatic metastatic carcinoma have lost the opportunity to surgery.the body gamma knife radiation therapy can improve the quality of life,small toxicity, and complications is acceptable.The PET/CT SUVmax value can be predicted the patient with pancreatic cancer using gamma knife radiotherapy prognosis.Part 2. Stereotaclic Body Radiotherapy with Metastatic Pancreatic CancerObjectiveTo discuss the clinical value of stereotactic radiotherapy for the treatment of metastatic pancreatic cancer.MethodsData 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),upper extremity synovial sarcoma (n=1).There are 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 3.6cm(range,1.6～1.7cm),median target volume 37.1cm3 (range, 11.1～72.1cm3), median GTV dose 50Gy(range,40～70Gy),patients treatment time is 14 to 22 days,5 fractions/week,median single dose 3Gy. The data were analyzed with SPSS 17.0 statistical software.Using Kaplan-Meier method to calculate the survival rate.Results1.The complete remission (CR) rate,the partial remission(PR) rate.the lesions stable rate.the disease efficiency rate,the local control rate was 23.5%(4/17).47.1% (8/17),11.8%(2/17),70.1%,and 82.3%,repectively.2.The total effective rate of the pain treatment was 100%,including the complete remission rate (CR)33.3%(3/9), the partial remission (PR) rate 55.6%(5/9), MR11.1%(1/9).3. The survival and local control rate for six-month patient was 71% and 100%, and for one-year patient was 35.3% and 100%.4.No Grade 3 or more acute and late radiation reaction was observed.4. The whole group of 17 patients all died at the end of follow-up,including the 12 casesdied of the distant metastasis and multiple organ failure,3 cases died of gastrointestinal bleeding,1 cases died of massive hemoptysis,1 cases died with unexplained.ConclusionThe majority of patients with pancreatic metastatic carcinoma have lost the opportunity to surgery,the stereotactic radiation therapy can improve the quality of life,local control rate,and small toxicity, complications is acceptable.