André T, Balosso J, Louvet C, Hannoun L, Houry S, Huguier M, Colonna M, Lotz J P, De Gramont A, Bellaïche A, Parc R, Touboul E, Izrael V
Department of Medical Oncology, University Hospital, Grenoble, France.
Int J Radiat Oncol Biol Phys. 2000 Mar 1;46(4):903-11. doi: 10.1016/s0360-3016(99)00478-2.
To evaluate a cisplatin-containing chemoradiotherapy (CRT) regimen followed by chemotherapy for unresectable (locally advanced group, n = 32) and resected (adjuvant group, n = 10) pancreatic adenocarcinoma. The quality of palliation and percentage of secondary resections were also studied for unresectable disease.
The protocol comprised CRT (45 Gy over 5 weeks), combined with 5-fluorouracil and cisplatin during the first and fifth weeks, followed, 3 weeks later, by 4 cycles of the same chemotherapy plus leucovorin.
All patients completed CRT but only 50% of each group finished the entire protocol. Gastrointestinal toxicity and weight loss were the major side effects during CRT. Enhanced hematological toxicity limited the post-CRT chemotherapy. For the locally advanced group, median survival was 9 months; 1- and 2-year survival rates were 31 and 12. 5%, respectively. The overall response rate was 16% and 50% had stable disease. A lasting palliative effect defined as improved performance status and decreased analgesic consumption, was recorded for 43% of the patients. Only three secondary resections have been performed. For the adjuvant group, median survival was 17 months.
Although toxic in advanced disease, this regimen significantly lowered pain and analgesic consumption, but had poor impact on secondary resectability. In an adjuvant setting, although equally toxic, this series was too small to allow conclusions to be drawn.
评估含顺铂的放化疗（CRT）方案联合化疗用于不可切除（局部晚期组，n = 32）及可切除（辅助治疗组，n = 10）胰腺腺癌的疗效。同时研究不可切除疾病的姑息治疗质量及二次切除率。
方案包括CRT（5周内45 Gy），在第1周和第5周联合5-氟尿嘧啶和顺铂，3周后进行4个周期相同化疗加亚叶酸钙。
所有患者均完成CRT，但每组仅50%完成整个方案。胃肠道毒性和体重减轻是CRT期间的主要副作用。血液学毒性增强限制了CRT后的化疗。对于局部晚期组，中位生存期为9个月；1年和2年生存率分别为31%和12.5%。总缓解率为16%，50%疾病稳定。43%的患者记录到持久的姑息效果，定义为功能状态改善和镇痛药物用量减少。仅进行了3次二次切除。对于辅助治疗组，中位生存期为17个月。
尽管该方案对晚期疾病有毒性，但显著降低了疼痛和镇痛药物用量，但对二次切除可能性影响不大。在辅助治疗中，尽管毒性相同，但该系列样本量太小，无法得出结论。
