Maurer C A, Zgraggen K, Büchler M W
Klinik für Viszerale und Transplantationschirurgie, Universität Bern.
Zentralbl Chir. 1999;124(5):401-7.
Increasing resection rates for pancreatic tumors and decreasing postoperative mortality rates in specialised centres let arise the question of an additional benefit of adjuvant therapy. Despite of extended and radical surgery the recurrence rates after resection of pancreatic cancer remain high. Several studies have indicated some chemo- and radiosensitivity of these tumors. Whether a (combination-)chemotherapy alone or a combined radiochemotherapy should be recommended can actually not be answered yet. However, adjuvant radiotherapy alone seems to be inferior to combined radiochemotherapy. Intraoperative radiotherapy as well as preoperative radiotherapy are not superior to postoperative percutaneous radiotherapy regarding recurrence rate and survival. Preoperative radiotherapy, preferably in combination with chemotherapy, should be considered in patients with non resectable or borderline resectable pancreatic tumors with the aim of downstaging and secondary resection. The preliminary results of regional adjuvant chemotherapy are impressing, but need to be confirmed in further, randomised studies. Overall, the availability of a good or even optimal adjuvant therapy for pancreatic cancer still seems to be far away. Therefore, all surgeons need to be encouraged to include their patients with resected pancreatic carcinoma in a current study protocol of adjuvant treatment, since only tenacious and multicentric research can lead to progress in this severe disease.
在专业中心，胰腺肿瘤切除率的提高以及术后死亡率的降低引发了辅助治疗是否具有额外益处的问题。尽管进行了扩大根治性手术，但胰腺癌切除术后的复发率仍然很高。多项研究表明这些肿瘤具有一定的化学敏感性和放射敏感性。目前实际上还无法回答是应推荐单纯（联合）化疗还是联合放化疗。然而，单纯辅助放疗似乎不如联合放化疗。就复发率和生存率而言，术中放疗以及术前放疗并不优于术后经皮放疗。对于不可切除或临界可切除的胰腺肿瘤患者，应考虑术前放疗，最好联合化疗，目的是降期并进行二期切除。区域辅助化疗的初步结果令人印象深刻，但需要在进一步的随机研究中得到证实。总体而言，胰腺癌良好甚至最佳辅助治疗方法的出现似乎仍遥遥无期。因此，需要鼓励所有外科医生将其接受胰腺癌切除术的患者纳入当前的辅助治疗研究方案，因为只有坚持不懈的多中心研究才能在这种严重疾病上取得进展。
