Lind Pehr A, Isaksson Bengt, Almström Markus, Johnsson Anders, Albiin Nils, Byström Per, Permert Johan
Department of Oncology, Karolinska-Stockholm Söder Hospital, Stockholm, Sweden.
Acta Oncol. 2008;47(3):413-20. doi: 10.1080/02841860701592384. Epub 2007 Sep 20.
The optimal care for patients with unresectable, non-metastatic pancreatic adenocarcinoma (PAC) is debated. We treated 17 consecutive cases with preoperative radiochemotherapy (RCT) as a means for downstaging their tumours and compared outcome with 35 patients undergoing direct surgery for primarily resectable PAC during the same time period.
The patients had biopsy proven, unresectable, non-metastatic PAC which engaged >or=50% of the circumference of a patent mesenteric/portal vein for a distance >or=2 cm and/or <50% of the circumference of a central artery for <2 cm. The preop therapy included two courses of Xelox (oxaliplatin 130 mg/m(2) d1; capecitabine 2 000 mg/m(2) d1-14 q 3 w) followed by 3-D conformal radiotherapy (50.4 Gy; 1.8 Gy fractions) with reduced Xelox (d1-5 q 1 w X 6).
No incident of RCT-related CTC Grade 3-4 haematologic and six cases of non-haematologic side-effects were diagnosed. Sixteen patients completed the RCT and were rescanned with CT and reevaluated for surgery 4 weeks post-RCT. Five cases were diagnosed with new metastases to the liver. Eleven patients were accepted for surgery whereof eight underwent a curative R(0)-resection. The median overall survival for the latter group was 29 months, which compared favourably with our control group of patients undergoing direct curative surgery for primarily resectable PAC (median OS: 16 months; R(O)-rate: 75%). Perioperative morbidity was similar in the two cohorts but the duration of surgery was longer (576 vs. 477 min) and the op blood loss was greater (3288 vs. 1460 ml) in the RCT-cohort (p < 0.05). The 30-day mortality was zero in both groups.
Preoperative RCT in patients with locally advanced PAC resulted in a high rate of curative resections and promising median survival in our treatment series. This trimodality approach merits further exploration in new studies, which are currently underway at our Department.
对于不可切除、非转移性胰腺腺癌（PAC）患者的最佳治疗方案存在争议。我们连续治疗了17例患者，采用术前放化疗（RCT）作为降低肿瘤分期的方法，并将结果与同期35例因原发性可切除PAC接受直接手术的患者进行比较。
患者经活检证实为不可切除、非转移性PAC，累及肠系膜/门静脉周长≥50%且长度≥2 cm，和/或中央动脉周长<50%且长度<2 cm。术前治疗包括两个周期的希罗达方案（奥沙利铂130 mg/m²，第1天；卡培他滨2000 mg/m²，第1 - 14天，每3周重复），随后进行三维适形放疗（50.4 Gy；每次1.8 Gy），同时希罗达方案减量（第1 - 5天，每周1次，共6周）。
未诊断出与RCT相关的3 - 4级血液学毒性事件，诊断出6例非血液学副作用。16例患者完成RCT，在RCT后4周进行CT复查并重新评估手术情况。5例患者被诊断出肝转移。11例患者接受手术，其中8例进行了根治性R(0)切除。后一组患者的中位总生存期为29个月，与我们因原发性可切除PAC接受直接根治性手术的对照组相比更具优势（中位总生存期：16个月；R(0)切除率：75%）。两组围手术期发病率相似，但RCT组手术时间更长（576分钟对477分钟），术中失血量更大（3288毫升对1460毫升）（p < 0.05）。两组30天死亡率均为零。
在局部晚期PAC患者中进行术前RCT导致了较高的根治性切除率，并且在我们的治疗系列中中位生存期前景良好。这种三联疗法值得在新的研究中进一步探索，目前我们科室正在开展相关研究。
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