Huguet Florence, Girard Nicolas, Guerche Clotilde Séblain-El, Hennequin Christophe, Mornex Françoise, Azria David
Groupe Coopérateur Multidisciplinaire en Oncologie, Service d'Oncologie Radiothérapie, Hôpital Tenon, 4 rue de Chine, 75020 Paris, France.
J Clin Oncol. 2009 May 1;27(13):2269-77. doi: 10.1200/JCO.2008.19.7921. Epub 2009 Mar 23.
Pancreatic carcinoma is one of the leading causes of cancer-related mortality. At time of diagnosis, 30% of patients present with a locally advanced unresectable but nonmetastatic pancreatic carcinoma (LAPC). The French program Standards, Options, and Recommendations was promoted to conduct a qualitative systematic review to evaluate the role of radiotherapy in patients with LAPC.
A search to identify eligible studies was undertaken using the MEDLINE database. All phase III randomized trials and systematic reviews evaluating the role of radiotherapy in LAPC were included, together with some noncontrolled studies if no phase III trials were retrieved. The quality and clinical relevance of the studies were evaluated using validated checklists, which allowed associating each result with a level of evidence.
Twenty-one studies were included, as follows: two meta-analyses, 13 randomized trials, and six nonrandomized trials. Chemoradiotherapy increases overall survival when compared with best supportive care (level of evidence C) or with exclusive radiotherapy (level B1), but is more toxic (level B1). Chemoradiotherapy is not superior to chemotherapy in terms of survival (level B1) and increases toxicity (level A). Recent data favor limited irradiation to the tumor volume (level C). Fluorouracil is still the reference chemotherapy in association with radiotherapy (level B1). Induction chemotherapy before chemoradiotherapy improves survival (level C).
No standard treatment exists, but there are two options for treatment of LAPC; these are gemcitabine-based chemotherapy and chemoradiotherapy. Induction chemotherapy followed by a chemoradiotherapy is a promising strategy for selection of patients without early metastatic/progressing disease.
胰腺癌是癌症相关死亡的主要原因之一。在确诊时，30%的患者表现为局部晚期不可切除但无转移的胰腺癌（LAPC）。法国的“标准、选择和建议”项目旨在进行一项定性系统评价，以评估放疗在LAPC患者中的作用。
使用MEDLINE数据库进行检索，以确定符合条件的研究。纳入所有评估放疗在LAPC中作用的III期随机试验和系统评价，若未检索到III期试验，则纳入一些非对照研究。使用经过验证的清单评估研究的质量和临床相关性，这使得每个结果都能与证据水平相关联。
共纳入21项研究，如下：两项荟萃分析、13项随机试验和6项非随机试验。与最佳支持治疗（证据水平C）或单纯放疗（证据水平B1）相比，放化疗可提高总生存率，但毒性更大（证据水平B1）。在生存率方面，放化疗并不优于化疗（证据水平B1），且会增加毒性（证据水平A）。近期数据支持对肿瘤体积进行有限照射（证据水平C）。氟尿嘧啶仍是与放疗联合使用的参考化疗药物（证据水平B1）。放化疗前进行诱导化疗可提高生存率（证据水平C）。
目前尚无标准治疗方案，但LAPC有两种治疗选择；即基于吉西他滨的化疗和放化疗。诱导化疗后进行放化疗是选择无早期转移/进展性疾病患者的一种有前景的策略。
