Tsai James Y, Iannitti David A, Safran Howard
Brown University Oncology Group, Providence, RI, USA.
Semin Oncol. 2003 Aug;30(4 Suppl 9):71-9. doi: 10.1016/s0093-7754(03)00273-2.
In spite of the high mortality in pancreatic cancer, significant progress is being made. This review discusses multimodality therapy for patients with pancreatic cancer. According to several phase II trials and Gastrointestinal Tumor Study Group results, improvements in locoregional control and survival may be achieved when chemotherapy is added to radiation for locally advanced pancreatic cancer. Radiosensitizing chemotherapy agents such as 5-fluorouracil, gemcitabine, paclitaxel, and cisplatin have shown promise. Selected patients with locally advanced disease have been downstaged with chemoradiation, facilitating surgical resection. For patients with resectable disease, the completion of Radiation Therapy Oncology Group study 97-04 represents a major achievement and brings gemcitabine into the forefront of adjuvant therapy. Neoadjuvant chemoradiation may eliminate the delay of initiating adjuvant treatment and spare unnecessary surgery for patients with rapid systemic progression. Molecular agents are being combined with chemoradiation in an attempt to delay or prevent systemic progression.
尽管胰腺癌死亡率很高，但仍在取得重大进展。本综述讨论了胰腺癌患者的多模式治疗。根据多项II期试验和胃肠道肿瘤研究组的结果，对于局部晚期胰腺癌患者，在放疗中加入化疗可实现局部区域控制和生存率的提高。5-氟尿嘧啶、吉西他滨、紫杉醇和顺铂等放射增敏化疗药物已显示出前景。部分局部晚期疾病患者经放化疗后分期降低，便于手术切除。对于可切除疾病的患者，放射治疗肿瘤学组97-04研究的完成是一项重大成就，并使吉西他滨成为辅助治疗的前沿药物。新辅助放化疗可消除启动辅助治疗的延迟，并避免对全身快速进展患者进行不必要的手术。分子药物正与放化疗联合使用，试图延缓或预防全身进展。
