Ridwelski K, Meyer F
Division of Oncosurgery/Oncology, Department of Surgery, University Hospital, Otto von Guericke University, Magdeburg, Germany.
Dig Dis. 2001;19(1):63-75. doi: 10.1159/000050655.
Palliative treatment is often the only remaining option in the management of pancreatic carcinoma, but its efficacy is poor due to low tumor sensitivity and inadequate treatment protocols. There are several options of palliative treatment with antitumor or supportive intention. Classical end points of palliative treatment are survival, tumor response, and quality of life. A decade ago, palliative chemotherapy consisted mainly of 5-fluorouracil as the standard agent in combination with either other agents and/or radiotherapy. Only the new antineoplastic drug gemcitabine, which was introduced simultaneously with the definition of novel end points of chemotherapy such as clinical benefit, allowed to achieve some progress. However, while gemcitabine monotherapy appeared to be superior to 5-fluorouracil and improved important parameters of quality of life, it could not provide a significant improvement of survival. A novel concept, therefore, is to improve this beneficial cytostatic response in pancreatic carcinoma using a gemcitabine-based protocol by combining it with antineoplastic drugs such as taxanes or platin analogs. This strategy may have the potential to improve the outcome in palliative chemotherapy of pancreatic carcinoma patients with advanced tumor growth or metastases. Best supportive care in pancreatic cancer consists of the treatment of symptoms, such as pain, jaundice, duodenal obstruction, weight loss, exocrine pancreatic insufficiency, and tumor-associated depression.
姑息治疗往往是胰腺癌治疗中仅存的选择，但由于肿瘤敏感性低和治疗方案不完善，其疗效不佳。有几种具有抗肿瘤或支持意图的姑息治疗选择。姑息治疗的经典终点是生存期、肿瘤反应和生活质量。十年前，姑息化疗主要是以5-氟尿嘧啶作为标准药物，与其他药物和/或放疗联合使用。只有新型抗肿瘤药物吉西他滨，在诸如临床获益等化疗新终点定义的同时被引入，才使得取得了一些进展。然而，虽然吉西他滨单药治疗似乎优于5-氟尿嘧啶并改善了生活质量的重要参数，但它并不能显著提高生存期。因此，一个新的概念是通过将基于吉西他滨的方案与紫杉烷类或铂类类似物等抗肿瘤药物联合使用，来改善胰腺癌这种有益的细胞毒性反应。这种策略可能有潜力改善晚期肿瘤生长或转移的胰腺癌患者姑息化疗的结局。胰腺癌的最佳支持治疗包括对症状的治疗，如疼痛、黄疸、十二指肠梗阻、体重减轻、胰腺外分泌功能不全以及肿瘤相关性抑郁。
