Goldstein D, Carroll S, Apte M, Keogh G
Department of Medical Oncology, Prince of Wales Hospital, New South Wales, Australia.
Intern Med J. 2004 Aug;34(8):475-81. doi: 10.1111/j.1444-0903.2004.00658.x.
Pancreatic cancer remains a fearsome disease. New insights into the molecular pathogenesis may influence choice of treatment modalities and provide avenues for novel therapeutic strategies for testing in the clinic. The survival rate of patients with all stages of disease is poor and clinical trials are appropriate alternatives for treatment and should be considered. Surgical resection, when possible, remains the primary treatment modality and can result in long-term cure. Less invasive techniques such as laparoscopy may reduce the rate of unnecessary laparotomies. The role of adjuvant therapy is re-emerging. Patients with unresectable and metastatic disease are incurable and optimal palliation is the goal. These patients may benefit from palliative bypass of biliary or duodenal obstruction if symptomatic. Pain associated with local tumour infiltration may be palliated with radiation, with or without chemotherapy, or with coeliac nerve blocks or local neurosurgical procedures. Chemotherapy with gemcitabine has modest objective response rates but has been shown to improve symptoms.
胰腺癌仍然是一种可怕的疾病。对分子发病机制的新见解可能会影响治疗方式的选择，并为在临床上进行测试的新型治疗策略提供途径。所有疾病阶段患者的生存率都很低，临床试验是合适的治疗替代方案，应予以考虑。手术切除在可能的情况下仍然是主要的治疗方式，并且可以实现长期治愈。诸如腹腔镜检查等侵入性较小的技术可能会降低不必要的开腹手术率。辅助治疗的作用正在重新显现。无法切除和转移性疾病患者无法治愈，最佳的姑息治疗是目标。如果出现症状，这些患者可能会从姑息性胆管或十二指肠梗阻旁路手术中受益。与局部肿瘤浸润相关的疼痛可以通过放疗（联合或不联合化疗）、腹腔神经阻滞或局部神经外科手术来缓解。吉西他滨化疗的客观缓解率适中，但已被证明可改善症状。
