Wayne Jeffrey D, Abdalla Eddie K, Wolff Robert A, Crane Christopher H, Pisters Peter W T, Evans Douglas B
The Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Oncologist. 2002;7(1):34-45. doi: 10.1634/theoncologist.7-1-34.
Pancreatic adenocarcinoma is the fifth leading cause of cancer-related death in the U.S. In spite of advancements in surgical treatment, nearly 80% of patients thought to have localized pancreatic cancer die of recurrent or metastatic disease when treated with surgery alone. Therefore, efforts to alter the patterns of recurrence and improve survival for patients with pancreatic cancer currently focus on the delivery of systemic therapy and irradiation before or after surgery. Postoperative adjuvant therapy appears to improve median survival. However, more than one-fourth of patients do not complete planned adjuvant therapy due to surgical complications or a delay in postoperative recovery of performance status. Utilizing a preoperative (neoadjuvant) approach, overall treatment time is reduced, a greater proportion of patients receive all components of therapy, and patients with rapidly progressive disease are spared the side effects of surgery as metastatic disease may be found at restaging following chemoradiation (prior to surgery). This paper examines the factors pertinent to clinical trial design for resectable pancreatic cancer, and carefully reviews the existing data supporting adjuvant and neoadjuvant therapy for potentially resectable disease.
胰腺癌是美国癌症相关死亡的第五大主要原因。尽管手术治疗取得了进展，但在仅接受手术治疗的情况下，近80%被认为患有局限性胰腺癌的患者死于复发或转移性疾病。因此，目前改变胰腺癌患者复发模式并提高生存率的努力主要集中在手术前后进行全身治疗和放疗。术后辅助治疗似乎能提高中位生存期。然而，超过四分之一的患者由于手术并发症或术后身体状况恢复延迟而未能完成计划的辅助治疗。采用术前（新辅助）治疗方法，可缩短总体治疗时间，更大比例的患者能接受所有治疗环节，并且对于疾病快速进展的患者，由于在放化疗（手术前）后重新分期时可能发现转移性疾病，可避免手术的副作用。本文探讨了与可切除胰腺癌临床试验设计相关的因素，并仔细回顾了支持对潜在可切除疾病进行辅助治疗和新辅助治疗的现有数据。
