Kim Hong Jin, Czischke Karen, Brennan Murray F, Conlon Kevin C
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
J Gastrointest Surg. 2002 Sep-Oct;6(5):763-9. doi: 10.1016/s1091-255x(02)00017-3.
Recent studies suggest that neoadjuvant chemoradiation can downstage locally advanced pancreatic tumors. There is limited evaluable data to support this approach. We review our experience with preoperative chemoradiation for surgically staged, locally advanced pancreatic cancer to determine whether patients are downstaged with multimodal therapy allowing for curative resection. A prospectively collected database from Memorial Sloan-Kettering Cancer Center was reviewed. Patients admitted between January 1993 and March 1999 with locally advanced pancreatic adenocarcinoma were identified (N = 163). Chemoradiation was administered to 87 (53.3%) of 163, and regimens varied from standard 5-fluorouracil/gemcitabine-based therapies to experimental protocols. Only three patients (3/87; 3.4%) had a sufficient clinical response on restaging to warrant reexploration. Of these, two thirds were unresectable on subsequent laparoscopy because of extensive vascular involvement or metastatic disease. Only one patient underwent a potentially curative resection, with a survival of 18 months despite negative margins and no nodal involvement. The overall median survival for all patients with locally advanced disease treated with chemoradiation was 11 months (6.5 months without multimodal therapy; P = 0.004). Although chemoradiation is associated with improved overall survival in locally advanced disease, it rarely leads to surgical "downstaging" allowing for potentially curative pancreatic resections. Novel multimodality approaches are required.
近期研究表明，新辅助放化疗可使局部晚期胰腺癌降期。但支持该方法的可评估数据有限。我们回顾了对手术分期为局部晚期胰腺癌患者进行术前放化疗的经验，以确定多模式治疗是否能使患者降期从而实现根治性切除。对纪念斯隆凯特琳癌症中心前瞻性收集的数据库进行了回顾。确定了1993年1月至1999年3月期间收治的局部晚期胰腺腺癌患者（N = 163）。163例患者中有87例（53.3%）接受了放化疗，治疗方案从基于标准5-氟尿嘧啶/吉西他滨的疗法到实验方案不等。只有3例患者（3/87；3.4%）在重新分期时有足够的临床反应，值得再次探查。其中，三分之二的患者在随后的腹腔镜检查中因广泛的血管受累或转移性疾病而无法切除。只有1例患者接受了可能的根治性切除，尽管切缘阴性且无淋巴结受累，但生存期为18个月。所有接受放化疗的局部晚期疾病患者的总体中位生存期为11个月（未接受多模式治疗的患者为6.5个月；P = 0.004）。虽然放化疗与局部晚期疾病患者的总体生存期改善相关，但它很少能导致手术“降期”从而实现可能的根治性胰腺切除术。需要新的多模式方法。
