Observation Of Curative Effect And Survival Analysis Of SBRT And IMRT For Unresectable Locally Advanced Pancreatic Cancer

Objective:To compare the curative effect,survival duration and toxic response of stereotactic body radiotherapy(SBRT)and intensity modulated radiotherapy(IMRT)for unresectable locally advanced pancreatic cancer.Methods:52 unresectable locally advanced pancreatic cancer patients were selected from Cancer Radiotherapy Center of the Fifth Affiliated Hospital of Zhengzhou University.The study period was from January 2014 to June 2017.Of all the 52 cases,12 cases were excluded due to the bad data quality.There were 40 cases remaining,among which 20 cases were subjected to the SBRT and 20 cases were subjected to the IMRT.According to the 8th TNM tumor staging of pancreatic cancer produced by the AJCC,the select patients belonged to the stage III and cannot be resected surgically.After three months' therapy,image examination was performed for both the SBRT treatment group and the IMRT treatment group.The observation variables included the patient's clinical data,efficiency,survival duration,control rate of the pain,CA19-9 level,total bilirubin level and toxic response to radiotherapy.Results: 1.Effectiveness: the 20 patients in the SBRT group had an average efficiency rate of 80%.The IMRT group had an average efficiency rate of 70%.There was no significant difference between the two groups(P>0.05),indicating that both of the radiotherapy methods have good effectiveness in the treatment and control of local lesions.2.Pain control: there was no significant difference in the NRS score before treatment between the SBRT group and the IMRT group(P>0.05).The NRS scores for the two groups of patients being subjected to treatment for 3 days,7 days were statistically significant different(P<0.05).By the end of the treatment,NRS scores were not significant between the two groups(P>0.05).3.CA19-9 level: the levels of CA19-9 in the SBRT group and the IMRT group were statistically significant different(P<0.05).4.Jaundice symptoms: after 3 months of treatment,the Jaundice symptoms was significantly reduced(P<0.05)by 83% and by 79% for the SBRT group and the IMRT group,respectively.The bilirubin levels in both groups after treatment were significantly lower(P<0.05)than those before treatment.5.Toxic response to radiotherapy: the main toxic responses were myelosuppression and digestive tract symptoms,with no toxic responses greater than Grade 3.The two groups had no significant difference in both the incidence of blood radiotoxicity(P>0.05)and the incidence of digestive toxicity(P>0.05).6.Survival duration: the median survival duration for the SBRT group and the IMRT group were 13 months and 12 months,respectively.The median progression-free survival duration for the SBRT group and the IMRT group were 6 months and 5 months,respectively.The two groups had significant difference(P<0.05)in the total survival duration,but no statistically significant difference(P>0.05)in the progression-free survival duration.Conclusions:Both SBRT and IMRT were effective in alleviating clinical symptoms including cancer pain and jaundice caused by the pancreatic cancer,reducing the level of CA19-9,and prolonging the survival duration of the patients.Compared with the IMRT treatment,the SBRT treatment showed greater performance in relieving the pain and jaundice symptoms,but lower toxic response rate.Both methods were effective in the treatment of the locally advanced unresectable pancreatic cancer.