细胞减灭术联合术中化疗热疗及术后放疗治疗晚期胰腺腺癌：可行性及疗效

Cytoreductive surgery combined with intraoperative chemo-hyperthermia and postoperative radiotherapy in the management of advanced pancreatic adenocarcinoma: feasibility aspects and efficacy.

作者信息

Kouloulias V E, Nikita K S, Kouvaris J R, Uzunoglu N K, Golematis V C, Papavasiliou C G, Vlahos L J

机构信息

Department of Radiotherapy, Medical School, University of Athens, Aretaieion Hospital, Greece.

出版信息

J Hepatobiliary Pancreat Surg. 2001;8(6):564-70. doi: 10.1007/s005340100026.

DOI:10.1007/s005340100026

PMID:11956909

Abstract

BACKGROUND/PURPOSE: The aim of our study was to evaluate the feasibility and the efficacy of cytoreductive surgery (CS) with intraoperative chemo-hyperthermia in the management of advanced stage IVA (T4N0M0) pancreatic cancer.

METHODS

From August 1995 through March 1996, seven patients with unresectable adenocarcinoma of the pancreas underwent CS, with preoperative chemotherapy (5-fluorouracil [FU] for 96 h), plus 45-Gy external beam postoperative irradiation with a 6-MeV linear accelerator (1.8 Gy per fraction, 5 days per week). A single session of intraoperative hyperthermia was performed with a waveguide-type applicator operating at 433 MHz, and temperature was measured by inserting a flexiguide needle catheter carrying a thermometry probe with three measuring points into the tumor. The tumor region was heated to 43 degrees C-45 degrees C for up to 60 min, while 5-FU 500 mg was injected simultaneously through the gastroduodenal artery into the splenic artery (intraoperative regional chemotherapy).

RESULTS

Postoperative recovery was uneventful for all patients. After the combined treatment, there was a significant decrease in the values of both serum carcinoembryonic antigen (CEA; P = 0.017, Wilcoxon test) and carbohydrate antigen (CA)19-9 ( P = 0.016; Wilcoxon test), from 7.6 +/- 1.5 ng/ml CEA and 869.6 +/- 126.9 U/ml CA to 3.5 +/- 0.8 ng/ml CEA and 104.7 +/- 35.4 U/ml CA19-9. Moreover, there was a significant improvement ( P = 0.016; Wilcoxon test) in Eastern Cooperative Oncology Group performance status, pain score, and body mass index. The median overall survival was 18.5 (SE, 1.8) months.

CONCLUSIONS

Our preliminary clinical results suggest the tolerability and the considerable potential advantage of using cytoreductive resection with preoperative chemotherapy, intraoperative chemo-hyperthermia, and external beam postoperative radiotherapy for the management of advanced adenocarcinoma of the pancreas.

摘要

背景/目的：本研究旨在评估细胞减灭术（CS）联合术中化疗热疗在晚期IVA期（T4N0M0）胰腺癌治疗中的可行性和疗效。

方法

1995年8月至1996年3月，7例无法切除的胰腺腺癌患者接受了细胞减灭术，术前进行化疗（5-氟尿嘧啶[FU]持续96小时），术后使用6兆伏直线加速器进行45戈瑞的外照射（每次分割剂量1.8戈瑞，每周5天）。使用工作频率为433兆赫的波导型施源器进行单次术中热疗，通过插入带有三个测量点的测温探头的柔性引导针导管测量肿瘤温度。将肿瘤区域加热至43摄氏度至45摄氏度，持续60分钟，同时通过胃十二指肠动脉向脾动脉注射5-氟尿嘧啶500毫克（术中区域化疗）。

结果

所有患者术后恢复顺利。联合治疗后，血清癌胚抗原（CEA；Wilcoxon检验，P = 0.017）和糖类抗原（CA）19-9（Wilcoxon检验，P = 0.016）值均显著下降，CEA从7.6±1.5纳克/毫升降至3.5±0.8纳克/毫升，CA19-9从869.6±126.9单位/毫升降至104.7±35.4单位/毫升。此外，东部肿瘤协作组的体能状态、疼痛评分和体重指数有显著改善（Wilcoxon检验，P = 0.016）。中位总生存期为18.5（标准误，1.8）个月。