Table_2_Efficacy of stereotactic body radiation therapy for locoregional recurrent pancreatic cancer after radical resection.docx

ObjectiveThis study aimed to analyze the efficacy and toxicity of stereotactic body radiotherapy (SBRT) for locoregional recurrent pancreatic cancer after radical resection.
MethodsPatients with locoregional recurrent pancreatic cancer after surgery treated with SBRT in our institution were retrospectively investigated from January 2010 to January 2020. Absolute neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) recorded at pretreatment were analyzed. Endpoints included overall survival (OS), progression-free survival (PFS) and cumulative incidences of local failure (LF) and metastatic failure (MF).
ResultsA total of 22 patients received SBRT with a median prescribed dose of 40 Gy (range of 30-50 Gy)/4 to 7 fractions. The median OS of all patients was 13.6 months (95% CI, 9.6-17.5 months). 0-1 performance status (HR 12.10, 95% CI 2.04-71.81, P=0.006) and ≤2.1 pre-SBRT NLR (HR 4.05, 95% CI 1.21-13.59, P=0.023) were significant predictors of higher OS on multivariable analysis. The median progression-free survival (PFS) of the cohort was 7.5 months (95% CI, 6.5-8.5 months). The median time to LF and MF were 15.6 months and 6.4 months, respectively. The rate of MF as a first event was higher than that of first event LF. Pain relief was observed in all patients (100%) 6 weeks after SBRT. In terms of acute toxicity, grade 1 including fatigue (6, 27.3%), anorexia (6, 27.3%), nausea (4, 18.2%) and leukopenia (4, 18.2%) was often observed. No acute toxicity of grade 4 or 5 was observed. In terms of late toxicity, no treatment-related toxicity was found during follow-up.
ConclusionThis study showed that SBRT can significantly reduce pain, effectively control local tumor progression, and have acceptable toxicity for patients with locoregional recurrence after radical resection of primary pancreatic cancer. Good performance status and lower pre-SBRT NLR were associated with improved overall survival.

研究目的 本研究旨在分析立体定向体部放疗（Stereotactic Body Radiotherapy, SBRT）用于根治性切除术后局部区域复发胰腺癌的疗效与毒性反应。研究方法 本研究回顾性分析了2010年1月至2020年1月期间，于本机构接受立体定向体部放疗的术后局部区域复发胰腺癌患者资料。分析了治疗前的绝对中性粒细胞与淋巴细胞比值（Neutrophil-to-Lymphocyte Ratio, NLR）以及血小板与淋巴细胞比值（Platelet-to-Lymphocyte Ratio, PLR）。研究终点包括总生存期（Overall Survival, OS）、无进展生存期（Progression-Free Survival, PFS）、局部失败（Local Failure, LF）累积发生率与转移失败（Metastatic Failure, MF）累积发生率。研究结果 本研究共纳入22例接受立体定向体部放疗的患者，中位处方剂量为40 Gy（范围30~50 Gy），分4~7个分割照射。所有患者的中位总生存期为13.6个月（95%置信区间：9.6~17.5个月）。多变量分析显示，行为状态评分为0~1分（风险比HR=12.10，95%置信区间：2.04~71.81，P=0.006）以及治疗前中性粒细胞与淋巴细胞比值≤2.1（HR=4.05，95%置信区间：1.21~13.59，P=0.023）是总生存期更长的显著预测因素。本队列的中位无进展生存期为7.5个月（95%置信区间：6.5~8.5个月）。局部失败与转移失败的中位发生时间分别为15.6个月与6.4个月，以转移失败为首次复发事件的比例高于局部失败作为首次复发事件的比例。立体定向体部放疗后6周，所有患者均获得疼痛缓解（100%）。急性毒性反应方面，常见1级毒性包括乏力（6例，27.3%）、食欲减退（6例，27.3%）、恶心（4例，18.2%）与白细胞减少（4例，18.2%），未观察到4级或5级急性毒性反应。晚期毒性反应方面，随访期间未发现与治疗相关的毒性事件。研究结论 本研究表明，对于原发性胰腺癌根治性切除术后出现局部区域复发的患者，立体定向体部放疗可显著缓解疼痛、有效控制局部肿瘤进展，且毒性反应可接受。良好的行为状态评分以及较低的治疗前中性粒细胞与淋巴细胞比值与更长的总生存期相关。