胰腺癌患者的新辅助术前放化疗

Neoadjuvant preoperative chemoradiation in patients with pancreatic cancer.

作者信息

Magnin Valerie, Moutardier Vincent, Giovannini Marie Helene, Lelong Bernard, Giovannini Marc, Viret Frederic, Monges Genevieve, Bardou Valerie Jeanne, Alzieu Claude, Delpero Jean Robert

机构信息

Department of Radiotherapy, Institut Paoli Calmettes, Marseille, France.

出版信息

Int J Radiat Oncol Biol Phys. 2003 Apr 1;55(5):1300-4. doi: 10.1016/s0360-3016(02)04157-3.

DOI:10.1016/s0360-3016(02)04157-3

PMID:12654441

Abstract

PURPOSE

To assess the toxicity and efficacy of preoperative chemoradiation in pancreatic cancer.

METHODS AND MATERIALS

Between November 1996 and December 2001, 32 patients with biopsy-proven pancreatic adenocarcinoma (28 head; 4 body) were treated by chemoradiation consisting of either split-course therapy (two courses of 15 Gy separated by a 2-week break, n = 10) or standard-fractionation therapy (45 Gy during 5 weeks, n = 22). Concurrent chemotherapy included continuous infusion of 5-fluorouracil and a cisplatin bolus. Pancreatic resection was scheduled for 4-6 weeks after completion of chemoradiation treatment.

RESULTS

All 32 patients completed the chemoradiation protocol. Only 2 cases of Grade 3 toxicity (weight loss, vomiting) and one fatal Grade 4 infection occurred. Of the 32 patients, 19 underwent curative resection. Two patients had a complete pathologic response. One patient died 36 months after diagnosis of late treatment-related toxicity (acute superior mesenteric artery thrombosis) with no evidence of disease. The 2-year overall survival rate for the entire group and the resected patients was 37.3% (95% confidence interval 18.2-56.4%) and 59.3% (95% confidence interval 34.1-84.9%), respectively.

CONCLUSION

Preoperative chemoradiation with 5-fluorouracil and cisplatin is feasible and promising.

摘要

目的

评估术前放化疗在胰腺癌治疗中的毒性和疗效。

方法和材料

1996年11月至2001年12月期间，32例经活检证实为胰腺腺癌的患者（28例胰头癌；4例胰体癌）接受了放化疗，其中包括分段治疗（两个疗程，各15 Gy，间隔2周，n = 10）或标准分割治疗（5周内45 Gy，n = 22）。同步化疗包括持续输注5-氟尿嘧啶和顺铂推注。放化疗结束后4至6周安排胰腺切除术。

结果

所有32例患者均完成了放化疗方案。仅发生2例3级毒性反应（体重减轻、呕吐）和1例致命的4级感染。32例患者中，19例行根治性切除术。2例患者达到完全病理缓解。1例患者在诊断为晚期治疗相关毒性反应（急性肠系膜上动脉血栓形成）36个月后死亡，无疾病证据。整个组和接受手术患者的2年总生存率分别为37.3%（95%置信区间18.2 - 56.4%）和59.3%（95%置信区间34.1 - 84.9%）。