Poen J C, Ford J M, Niederhuber J E
Department of Radiation Oncology, Stanford University, California 94305, USA.
Ann Surg Oncol. 1999 Jan-Feb;6(1):117-22. doi: 10.1007/s10434-999-0117-1.
In western countries, carcinoma of the pancreas remains the most lethal of the common malignancies. Even the favorable "organ-confined" tumors present a considerable challenge. The lack of anatomic barriers to local infiltration and the biological propensity for early lymphatic, perineural, and vascular invasion are nearly insurmountable obstacles to complete surgical eradication of this malignancy. Various combinations of chemotherapy and radiotherapy (RT) have been used with marginal but measurable success. Earlier trials conducted by the Gastrointestinal Tumor Study Group established roles for 5-fluorouracil chemotherapy and RT in the treatment of patients with resectable or locally advanced pancreatic cancer. More recently, computed tomography-guided conformal RT and a variety of intraoperative RT techniques have enabled more reliable sterilization of the local surgical field and escalation of doses to potentially curative levels (7000 cGy) for unresectable lesions. Chemotherapy dose intensification through the use of portable programmable pumps for protracted venous infusions and the development of active systemic agents in addition to 5-fluorouracil suggest that an effective combination chemotherapeutic regimen might soon be developed. This report reviews the current standards of practice and integrates recent developments to construct a modern algorithm for the use of chemoradiotherapy in the management of localized (nonmetastatic) pancreatic cancer. The likely directions of future investigations are also discussed.
在西方国家，胰腺癌仍然是常见恶性肿瘤中致死率最高的。即使是预后较好的“局限于器官”的肿瘤也带来了相当大的挑战。缺乏阻止局部浸润的解剖学屏障以及早期发生淋巴、神经周围和血管侵犯的生物学倾向，几乎是彻底手术根除这种恶性肿瘤无法逾越的障碍。化疗和放疗（RT）的各种联合应用取得了一定但有限的成功。胃肠道肿瘤研究组早期进行的试验确定了5-氟尿嘧啶化疗和放疗在可切除或局部晚期胰腺癌患者治疗中的作用。最近，计算机断层扫描引导的适形放疗和多种术中放疗技术已能更可靠地清除局部手术区域的肿瘤，并将不可切除病变的剂量提高到潜在治愈水平（7000 cGy）。通过使用便携式可编程泵进行长时间静脉输注来强化化疗剂量，以及除5-氟尿嘧啶外开发活性全身药物，这表明可能很快会研发出一种有效的联合化疗方案。本报告回顾了当前的实践标准，并结合近期进展构建了一种用于局部（非转移性）胰腺癌管理中使用放化疗的现代算法。还讨论了未来研究可能的方向。
