Chandler Nicole M, Canete Jonathan J, Stuart Keith E, Callery Mark P
Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
J Hepatobiliary Pancreat Surg. 2003;10(1):61-6. doi: 10.1007/s10534-002-0736-5.
Despite advancements in the field of surgical oncology, the diagnosis of pancreatic cancer still carries a grave and dismal prognosis. Surgery alone for adenocarcinoma of the pancreatic head or uncinate process has a median survival time of 12 months. These grim statistics have led many to study the effects of combined multimodality therapy in the fight against pancreatic cancer. The long recovery time associated with pancreaticoduodenectomy has resulted in as many as 25% of patients unable to proceed with planned adjuvant therapy. For these reasons preoperative or neoadjuvantc hemoradiation therapy (CRT) has been evaluated. Pre-operative CRT ensures that all eligible patients receive the benefits of multimodality therapy, and patients who manifest metastatic disease on restaging evaluations are spared the morbidity of an unnecessary laparotomy. Multimodality therapy appears to lengthen the survival duration in patients with pancreatic cancer. It also affords a selection advantage, in that patients with aggressive disease biology with advanced metastatic disease following CRT are spared the morbidity of surgery. Conversely, a limited subset of patients may even be downstaged, allowing for a potentially curative resection. In this article we review the current status of neoadjuvant chemoradiation in adenocarcinoma of the pancreas. We discuss its rationale in light of the reported strengths and weaknesses of postoperative adjuvant CRT.
尽管外科肿瘤学领域取得了进展，但胰腺癌的诊断仍然预后严重且不容乐观。仅针对胰头或钩突腺癌进行手术，其平均生存时间为12个月。这些严峻的数据促使许多人研究联合多模式疗法在对抗胰腺癌中的效果。与胰十二指肠切除术相关的漫长恢复时间导致多达25%的患者无法进行计划好的辅助治疗。出于这些原因，术前或新辅助放化疗（CRT）已得到评估。术前CRT可确保所有符合条件的患者受益于多模式疗法，并且在重新分期评估中显示有转移性疾病的患者可避免不必要的剖腹手术带来的并发症。多模式疗法似乎能延长胰腺癌患者的生存时间。它还具有选择优势，因为在CRT后患有侵袭性疾病生物学特征且有晚期转移性疾病的患者可避免手术带来的并发症。相反，一小部分患者甚至可能降期，从而有可能进行根治性切除。在本文中，我们回顾了胰腺癌新辅助放化疗的现状。我们根据已报道的术后辅助CRT的优缺点来讨论其基本原理。
