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Abstract：
BACKGROUND: The present study aimed to evaluate proton beam therapy (PBT) for stage IV pancreatic adenocarcinoma and its metastases and define the criteria for eligibility. Materials and methods: We retrospectively evaluated the patients who had a histopathological diagnosis of pancreatic adenocarcinoma, had progressed to stage IV, and underwent PBT for both the primary and some metastatic lesions between 2017 and 2022. PBT was performed using the passive scattering technique.
RESULTS: Sixteen patients (median age, 72 years; range, 55-85 years) were enrolled. All patients had stage IV pancreatic cancer at the initiation of PBT. The median duration from the date of stage IV diagnosis to the initiation of PBT was 5.8 (range, 0.4-13.5) months. Three patients had been diagnosed as having recurrent stage IV cancer at other institutions before their referral to our hospital because they had local recurrence and distant metastases after the resection of the primary tumor. Chemotherapy was as follows: pre-PBT, 0, 1, 2, and 3 lines in 4, 7, 4, and 1 patients, respectively; concurrent with PBT, 0 and 1 line in 11 and 5 patients, respectively; post-PBT, 0 and 1 line in 5 and 5 patients, respectively; and unknown, 6 patients. The median survival times (MSTs) from the date of stage IV diagnosis for the with or without non-irradiated active metastatic tumor were 11.4 and 20.1 months, respectively. Univariate analysis revealed that the performance status (PS) levels (p < 0.01), the carbohydrate antigen (CA) 19-9 tumor marker levels (p < 0.01), active tumors not treated with irradiation (p = 0.02), and with or without post-PBT chemotherapy (p < 0.01) were statistically significant factors. Multivariate analysis revealed that the CA 19-9 tumor marker levels (p= 0.04), the number of metastatic lesions (p = 0.049), and with or without non-irradiated active metastatic tumors (p = 0.02) were significant factors.
CONCLUSIONS: PBT is indicated when the number of metastases is limited to ≤ 4 lesions and all tumors can be irradiated within the smallest possible number of irradiation fields that can be performed within the patient\'s tolerable time, which is a subjective duration that depends on the patient\'s reaction during each session. It may be a viable treatment option for patients with oligometastatic pancreatic cancer.
RESULTS: Sixteen patients (median age, 72 years; range, 55-85 years) were enrolled. All patients had stage IV pancreatic cancer at the initiation of PBT. The median duration from the date of stage IV diagnosis to the initiation of PBT was 5.8 (range, 0.4-13.5) months. Three patients had been diagnosed as having recurrent stage IV cancer at other institutions before their referral to our hospital because they had local recurrence and distant metastases after the resection of the primary tumor. Chemotherapy was as follows: pre-PBT, 0, 1, 2, and 3 lines in 4, 7, 4, and 1 patients, respectively; concurrent with PBT, 0 and 1 line in 11 and 5 patients, respectively; post-PBT, 0 and 1 line in 5 and 5 patients, respectively; and unknown, 6 patients. The median survival times (MSTs) from the date of stage IV diagnosis for the with or without non-irradiated active metastatic tumor were 11.4 and 20.1 months, respectively. Univariate analysis revealed that the performance status (PS) levels (p < 0.01), the carbohydrate antigen (CA) 19-9 tumor marker levels (p < 0.01), active tumors not treated with irradiation (p = 0.02), and with or without post-PBT chemotherapy (p < 0.01) were statistically significant factors. Multivariate analysis revealed that the CA 19-9 tumor marker levels (p= 0.04), the number of metastatic lesions (p = 0.049), and with or without non-irradiated active metastatic tumors (p = 0.02) were significant factors.
CONCLUSIONS: PBT is indicated when the number of metastases is limited to ≤ 4 lesions and all tumors can be irradiated within the smallest possible number of irradiation fields that can be performed within the patient\'s tolerable time, which is a subjective duration that depends on the patient\'s reaction during each session. It may be a viable treatment option for patients with oligometastatic pancreatic cancer.
摘要：
背景：本研究旨在评估IV期胰腺腺癌及其转移的质子束治疗（PBT），并确定合格标准。材料和方法：我们回顾性评估了组织病理学诊断为胰腺腺癌的患者，已经进展到第四阶段，并在2017年至2022年期间接受了原发性和一些转移性病变的PBT。使用被动散射技术进行PBT。
结果：16例患者（中位年龄，72年；范围，55-85岁）注册。所有患者在PBT开始时都患有IV期胰腺癌。从IV期诊断到开始PBT的中位持续时间为5.8（范围，0.4-13.5）个月。在转诊到我们医院之前，有三名患者在其他机构被诊断为复发性IV期癌症，因为他们在切除原发肿瘤后有局部复发和远处转移。化疗如下：PBT前，4、7、4和1例患者的0、1、2和3行，分别；与PBT同时，11例和5例患者中的0和1行，分别；PBT后，5和5例患者中的0和1行，分别；和未知，6名患者。有或没有未照射的活动性转移性肿瘤的自IV期诊断之日起的中位生存时间（MST）分别为11.4和20.1个月，分别。单因素分析显示，绩效状态(PS)水平(p<0.01)，糖类抗原（CA）19-9肿瘤标志物水平（p<0.01），未接受放射治疗的活动性肿瘤（p=0.02），和有或没有PBT后化疗（p<0.01）是有统计学意义的因素。多因素分析显示，CA19-9肿瘤标志物水平(p=0.04)，转移灶的数量（p=0.049），有无未照射的活动性转移性肿瘤（p=0.02）是重要因素。
结论：当转移灶的数量限制在≤4个病灶，并且所有肿瘤都可以在患者的耐受时间内进行最小数量的照射范围内进行照射时，这是一个主观的持续时间，取决于病人的反应在每个疗程。它可能是寡转移胰腺癌患者的可行治疗选择。
结果：16例患者（中位年龄，72年；范围，55-85岁）注册。所有患者在PBT开始时都患有IV期胰腺癌。从IV期诊断到开始PBT的中位持续时间为5.8（范围，0.4-13.5）个月。在转诊到我们医院之前，有三名患者在其他机构被诊断为复发性IV期癌症，因为他们在切除原发肿瘤后有局部复发和远处转移。化疗如下：PBT前，4、7、4和1例患者的0、1、2和3行，分别；与PBT同时，11例和5例患者中的0和1行，分别；PBT后，5和5例患者中的0和1行，分别；和未知，6名患者。有或没有未照射的活动性转移性肿瘤的自IV期诊断之日起的中位生存时间（MST）分别为11.4和20.1个月，分别。单因素分析显示，绩效状态(PS)水平(p<0.01)，糖类抗原（CA）19-9肿瘤标志物水平（p<0.01），未接受放射治疗的活动性肿瘤（p=0.02），和有或没有PBT后化疗（p<0.01）是有统计学意义的因素。多因素分析显示，CA19-9肿瘤标志物水平(p=0.04)，转移灶的数量（p=0.049），有无未照射的活动性转移性肿瘤（p=0.02）是重要因素。
结论：当转移灶的数量限制在≤4个病灶，并且所有肿瘤都可以在患者的耐受时间内进行最小数量的照射范围内进行照射时，这是一个主观的持续时间，取决于病人的反应在每个疗程。它可能是寡转移胰腺癌患者的可行治疗选择。
