Rau H G, Wichmann M W, Wilkowski R, Heinemann V, Sackmann M, Helmberger T, Dühmke E, Schildberg F W
Chirurgische Klinik und Poliklinik, Ludwig-Maximilian-Universität, Klinikum Grosshadern, Marchioninistrasse 15, 81377 München.
Chirurg. 2002 Feb;73(2):132-7. doi: 10.1007/s00104-001-0363-7.
So far, surgery represents the only prospect for cure in patients with pancreatic cancer. Most patients, however, present with locally advanced pancreatic cancer at primary diagnosis. Recently, novel therapeutic regimens with preoperative radiochemotherapy have been developed that may improve long-term survival and resectability rates of patients with locally advanced pancreatic cancer.
This feasibility study evaluates the preliminary results of neoadjuvant therapy with gemcitabine and 5-fluorouracil (5-FU) or cisplatin. Twenty-six patients suffering from locally advanced pancreatic cancer were considered for preoperative radiochemotherapy. They received radiation (45 Gy) and chemotherapy with simultaneous or sequential gemcitabine and 5-FU (n = 15) or gemcitabine and cisplatin (n = 11) administration prior to surgical resection.
Mean patient age was 62.4 +/- 2.6 years and 62% (n = 16) were male. The response rate was 69%, and 11 patients underwent curative surgical resection of the pancreatic cancer. Nine Whipple procedures and two complete pancreatectomies were carried out. In five patients a total of eight surgical complications were observed. Median overall survival was 9.8 months after primary cancer diagnosis (mean 12.0 +/- 1.2). During follow-up no local recurrent disease was detected.
Our findings lead us to conclude that preoperative chemoradiation with 45 Gy, gemcitabine and 5-FU or cisplatin is a powerful therapeutic tool in patients with locally advanced non-resectable pancreatic cancer. Major resections, including vascular reconstructions, are nonetheless associated with increased mortality. Preoperative chemoradiation contributes to improved survival in patients with primary non-resectable pancreatic cancer.
到目前为止，手术是胰腺癌患者唯一的治愈希望。然而，大多数患者在初次诊断时就已出现局部晚期胰腺癌。最近，已开发出术前放化疗的新型治疗方案，这可能会提高局部晚期胰腺癌患者的长期生存率和可切除率。
本可行性研究评估了吉西他滨与5-氟尿嘧啶（5-FU）或顺铂新辅助治疗的初步结果。26例局部晚期胰腺癌患者接受术前放化疗。在手术切除前，他们接受了45 Gy的放疗以及同时或序贯给予吉西他滨和5-FU（n = 15）或吉西他滨和顺铂（n = 11）的化疗。
患者平均年龄为62.4±2.6岁，62%（n = 16）为男性。缓解率为69%，11例患者接受了胰腺癌的根治性手术切除。实施了9例惠普尔手术和2例全胰切除术。5例患者共出现8例手术并发症。原发性癌症诊断后的中位总生存期为9.8个月（平均12.0±1.2）。随访期间未检测到局部复发性疾病。
我们的研究结果使我们得出结论，45 Gy、吉西他滨与5-FU或顺铂的术前放化疗是局部晚期不可切除胰腺癌患者的一种有效治疗手段。然而，包括血管重建在内的大型切除术会增加死亡率。术前放化疗有助于提高原发性不可切除胰腺癌患者的生存率。
