清胰化积方联合高强聚焦超声消融治疗化疗失败晚期胰腺癌的临床疗效观察

Clinical Observation of High Intensity Focused Ultrasound (HIFU) Ablation Combined with Qingyihuaji Formula for SalvageTreatment for Advanced Pancreatic Cancer Patients Failed to Systemic Chemotherapy

摘要: 目的：研究高强度聚焦超声(HIFU)胰腺肿瘤局部消融联合清胰化积方治疗化疗失败的中晚期胰腺癌临床疗效观察。方法：采用HIFU联合清胰化积方治疗29例中晚期胰腺癌患者，其中发生肝、后腹膜淋巴结等部位转移23例，局部晚期6例。本研究主要观察联合治疗疗效、生存期、疼痛变化及并发症等情况。结果：29例患者均可进行近期疗效评估，部分缓解3例(10.3%)，稳定7例(24.1%)，进展19例(65.5%)，有效率(RR)10.3% (3例)，疾病控制率(DCR)为34.5%。中位无疾病进展时间(PFS)为2.8个月，中位总生存时间(OS)8.1个月。75%患者疼痛获得了不同程度的减轻。治疗后的KPS评分为78.5  6.4，高于治疗前64.5  4.2，差异有统计学意义(P < 0.05)。不良反应主要以1~2级消化道反应为主，未出现骨髓毒性、上消化道出血或胃肠穿孔等严重并发症。结论：HIFU联合中药治疗化疗失败的中晚期胰腺癌具有一定临床疗效、且毒副作用轻，值得临床进一步研究。

Abstract: Objective: To evaluate the efficacy and toxicity of high intensity focused ultrasound (HIFU) for local ablation of pancreatic tumor combined with Qingyihuaji formula as the palliative treatment for advanced pancreatic cancer patients failed to systemic chemotherapy. Methods: 29 advanced pancreatic cancer patients who failed systemic chemotherapy accepted HIFU and Qingyihuaji formula treatment from January 2012 to December 2013. The occurrence of liver, retroperitoneal, and other parts of the metastasis in 23 cases, 6 cases of local advanced. The curative effects, the pain changes and toxicity were evaluated, and progression-free survival (PSF) and over survival (OS) were calculated from the date of follow-up. Results: All the 29 patients can receive the short-term efficacy evaluation. There were 3 cases of partial response (PR), 7 of stable disease (SD) and 19 of progressive disease (PR) with RR of 10.3% and DCR of 34.5%. The median PFS and OS were 2.5 and 8.1 months, respectively. 75% patients reported significant reductions in their pain levels. The KPS was 78.5  6.4 after combination treatment, higher than 64.5  4.2 before treatment. The major side effect was grade 1 - 2 gastrointestinal response. There were no marrow toxicities and serious complications such as gastrointestinal hemorrhage or perforation of gastrointestinal tract. Conclusion: HIFU for local ablation of pancreatic tumor combined with traditional Chinese medicine in the treatment of failure of chemotherapy in advanced pancreatic cancer is safe, effective, and light toxicity, worthy of further clinical study.