| Object: Pancreatic cancer is a common refractory tumors, and the majority of lesions werelocated in the pancreatic head, about 90% of it originated in the glandular epithelial tubeadenocarcinoma, and the incidence rate of about 1% to 2% of the systemic cancer.The currenttreatment methods include surgery, radiotherapy, chemotherapy and biological targeted therapy,but radical surgical resection is the only chance of cure means. However, because early diagnosisis more difficult , most patients are diagnosed at an advanced stage, who lost theopportunity of surgical treatment,and can be treated surgically only 10% ~ 20%, The prognosisis poor, the 5-year overall survival rate of less than 5%.Inoperable patient outcomes are worse,with an average survival of 5-7 months. Therefore, to explore how to extend the lifetimeof locally advanced pancreatic cancerand improve quality of life, is currently one of the hotspots.The patients with locally advanced pancreatic cancer can not surgery, and only rely onradiotherapy and chemotherapy for palliative treatment, but systemic chemotherapy effects islow and toxicity is high.Because traditional radiotherapy can not accurately show therelationship between the location of the tumor and surrounding vital organs, and the sensitivetissue around the tumor,and has severe toxicity, so it is difficult to achieve tumor cure dose,andthe efficacy is poorer. In recent years, as technologycontinues to progress in radiotherapy, therehas been a lot of precise radiotherapy Means of conventional radiotherapy.Bodyγ-knife, namely stereotactic Body gamma-ray body radiation therapy system, is a fusionof stereotactic techniques, surgical techniques and modern computer technology inone, stereotactic radiation therapy equipment . Compared with conventional radiotherapy, it hasa high dose of radiation oncology,surrounding normal tissue damage, and is becomingincreasingly important. Stereotactic gamma knife in the destruction of tumor cells, at the sametime with otherradiotherapy, can also damage normal tissue, such as the destructionof the immune function, bone marrow suppression,damage to normal tissue radiation injury,anddamage to liver function. And it directly affects the treatment and the patients’ quality oflife.Compound kushen injection is pure Chinese medicine,which is make up of matrine.oxymatrine and other alkaloids, its major role is to relieve pain, reduce radiationtoxicity,protec of bone marrow function, and treat the tumor,This clinical study is in order toobserve the effect of the whole body gamma knife joint compoundkushen injection,includinga short-term clinical efficacy and toxicity of treatment of pancreatic cancer.Methods: Retrospective analysis of 63 patients with locally advanced pancreatic cancerpatients in our hospital, who were conducted dimensional gamma knife treatment, and 31cases at the same time were given the infusion of Compound Kushen injection.Thethree-dimensiona Gamma Knife treatment was the equipment of SGS-I stereotacticgamma-ray total body irradiation treatment system (Super Gamma Knife). Specific methods: Thepatient supine on the three-dimensional coordinates of the stereotactic bodyframe, And thebody frame has built-in vacuum bags, Which was vacuummed forming and fixed body.Patients were in the empty stomach for 4 ~ 6h before started CT localization scan , and drinkedcontrast agent for 200 ~ 300ml before scanned half an hour and before drinked againcontrast agent for 300ml before localized then proceed enhanced CT (enhanced drug iohexol)scan under the conditions of calm breathing;Scan range: Thoracic 10 vertebrallevel to the levelof the L4 vertebral body, the scan-storey 3~5 mm, obtain positioning images;In the treatment planning system (treatment plan, TPS), Reconstruct anddisplay a three-dimensional image; Theplanning target volume (planning target volume, PTV) according to tumorlocation, clinicaltarget volume (clinical the target volume, CTV), the Physical condition of patients andtherapeutic purposes was developed the radiation treatment planning and adjustment of the dosedistribution.PTV coverage of the CTV more than 95% , isodose curve of 50 % to 65%, asingletumor≤5 cm peripheral dose of 4 Gy of tumor> 5 cm in a single periphe-ral doseof2.8 to 3.6 Gy of;Peripheral dose of a single repeat did not allow positioning the X-axis and Z-axisdirection and positioning error, the Y-axis error is less than 2 mm, The total treatment dosewas number of 3500 ~ 4500cGy, that were divided doses of 300 to 400 cGy. the of treatmentswere 8 to 12 times ,and most patients were treated daily for five times every week，whofinished of treatment at the end of the 2 ~ 3 weeks. target adjacent to the part of the duodenumby 15% to30% . Treatment groups: Before the Gamma Knife treatment，patients in the weekwere given infusion combined Matrine injection of 30 ml / time,1/ d, and 21d was a cycle,andStarted treat for Gamma Knife ment afte one week;Control group: a simple line of GammaKnife treatment. 3 months after the end of the treatment review, clinical benefit response (CBR),the WHO solid tumor criteria and adverse reactions criteria for efficacy evaluation.Results: Gamma Knife treatment group, the clinical benefit response rate was 90.7% (29/32),control group 71.0% (22/31), the two groups was significant difference (P <0.05); term efficacyfor the treatment group 81.2% (26/32), the control group was 54.8% (17/31), the two groupswas significant difference (P<0.05); After treatment, total CA19-9 indicators than beforetreatment, reduced significantly, the differences were statistically significant (P <0 01), butbetween the two groups showed no significant difference (P>0.05); Hematological toxicityduring the Gamma Knife treatment, the treatment groupleukopenia incidence rateof 25.0% (8/32), the control group was 51.6% (16/31), two groups were compared, the differencewas statistically significant (P <0.05),but two sets of red blood cells and platelets were notchanged significantly; adverse reaction Africa hematological toxicity, gastrointestinal tract of thetreatment group response rate was 40.6% (13/32), and gastrointestinal reactions in the controlgroup was 51.6% (16/31), the two groups campared，there was no significant difference (P>0.05).Conclusion:Using stereotactic gamma knife radiosurgery for the clinical diagnosis of inoperableadvanced pancreatic cancer patients,whose Palliative analgesic effect was good, the role ofjaundice was quick, CA19-9 was decreased rapidly , the recent treatment was good, quality oflife could be improved, and side effects could be tolerated. Gamma Knife really opened up anew avenue for the treatment of pancreatic cancer .Plus Compound Kushen after injection couldbe significantly attenuated synergy, and good ancillary drugs could be used as the stereotacticgamma knife treatment process. At present, the incidence of pancreatic cancer is still an upwardtrend, through this study, to meet the need for treatment of more patients with pancreaticcancer, many patients with pancreatic cancer are benefitting. |
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