摘要
目的探讨肝外胆道恶性肿瘤切除术后辅助放化疗的临床价值和安全性。方法 2003年1月—2007年12月,45例肝外胆道恶性肿瘤患者在我院实施手术,其中外科切缘病理阴性(R0切除)24例、阳性(R1/R2切除)21例,伴区域淋巴结癌细胞浸润27例。术后给予辅助放疗(36～50 Gy)及3～6个疗程化疗(第1天奥沙利铂130 mg/m2,第1～14天卡培他滨2 000 mg/m2,21 d为1个疗程)。随访5年,观察术后肿瘤局部控制、局部复发或转移情况,分析中位生存期、5年总生存率及放化疗不良反应。结果本组患者均接受了术后辅助放化疗及随访。中位化疗周期数4.5个,中位放疗剂量42 Gy;中位随访32个月,中位生存期36个月。至随访终点16例仍存活,其中14例无瘤生存;除1例术后13个月失访外,其余患者死于肿瘤局部失控或伴远处转移(腹膜、肝、肺、骨),原发肿瘤局部淋巴结远处转移(tumor lymbp node metastasis,TNM)分期≥Ⅲ期患者占92.9%(26/28)。5年内肿瘤局部控制率66.7%(30/45),外科切缘病理阴性、阳性患者的局部控制率分别为83.3%(20/24)、47.6%(10/21)(P<0.005)。患者5年的总生存率为35.6%(16/45),外科切缘病理阴性患者和阳性患者的总生存率分别为58.3%(14/24)和9.5%(2/21)(P<0.005)。TNM分期早(Ⅰ、Ⅱ)与分期晚(Ⅲ、Ⅳ)患者的中位生存期分别为50个月和21个月(P=0.035)。辅助放化疗治疗不良反应轻微,多为1～2度;无患者因不良反应而完全中断治疗。结论根治性外科手术(R0切除)是肝外胆道恶性肿瘤患者长期生存的重要因素。术后辅助放化疗有益于患者肿瘤的局部控制,提高了中位生存期和5年的总生存率;外科切缘病理阴性患者优于阳性患者;安全及耐受性好,有待于进一步深入探讨研究。
Objective To observe and assess the clinical efficacy and safety of neo-adjuvant radio-chemotherapy in the patients with resected extrahepatic biliary duct carcimomas. Methods Forty five patients with extrahepatic biliary duct carcinomas treated with surgery and subsequent re- ceived adjuvant radiotherapy （dose 36 50 Gy） from Jan 2003 to December 2007. Concurrent neo- chemotherapy was delivered to the patients （Oxaliplatin 130 mg/m2, given intravenoLis, day 1; Capecitabine 2 000 mg/m2 ,oral,day 1- 14; regimen repeated every 21 days and no more than 6 cy- cles）. Surgery margins were negative in 24 patients （R0 resection）, positive in 21 patients（ RI/R2 resection）. Twenty seven patients had metastatic nodal involvement. The defined follow-up time for all patients was within 5 years. Results All patients received postoperative neo-adjuvant radio- chemotherapy and follow up. The median chemotherapy cycles and radiation dose were 4.5 times and 42 Gy respectively. The median follow up and overall median survival was 32 and 36 months re- spectively. To the end of follow up, 16 patients was still alive （ 14 cases relapse-free）. Majorities of patients died of cancer transformation and one was lost to follow up by 13 months after treatment. The 5-year actuarial loco-regional control rate was 66.7% （30/45） （83.3% and 47.6% for pa- tients with negative and positive margins respectively, P〈0. 005 ）. The 5-year overall survival was of 35.6% （16/45） for the entire group （58.3% in ease of negative margins and 9.5% in that of posi- tive margins, P〈0. 005）. The median survival of patients with early classification of TNM （ I, II ） was 50 months, significantly longer than that of late classification of TNM （ BI, IV ） （21 months,P〈 O. 05）. The radio-chemotherapy with mild adverse effects （G1-2） was tolerable. Only 3 patients developed a major chemoradiation-induced grade 3 toxicity. No patients required complete interrup- tion of radio=chemotherapy for their toxicity. Conclus
出处
《转化医学杂志》
2013年第5期290-294,共5页
Translational Medicine Journal
关键词
肝外胆道肿瘤
胆管癌
胆囊癌
壶腹癌
药物疗法
放射疗法
Extrahepatic biliary duct carcinomas
Cholangiocarcinoma
Gallbladder carcinoma
Ampullary carcinoma
Drug therapy
Radiotherapy
