Turrini Olivier, Viret Frédéric, Moureau-Zabotto Laurence, Guiramand Jérome, Moutardier Vincent, Lelong Bernard, de Chaisemartin Cécile, Giovannini Marc, Delpero Jean-Robert
Department of Surgical Oncology, Institut Paoli-Calmettes and Université de la Méditerranée Marseille, Marseille, France.
Oncology. 2009;76(6):413-9. doi: 10.1159/000215928. Epub 2009 May 4.
It is the aim of this study to assess the outcome of patients who received neoadjuvant 5-fluorouracil-cisplatin chemoradiation (CRT) for stage I/III pancreatic adenocarcinoma.
Eligible patients (n = 101) received radiation therapy (45 Gy) associated with continuous infusion of 5-fluorouracil accompanied by a cisplatin bolus.
Of the 102 patients enrolled in the study, 26 patients had progression of cancer during treatment and were deemed unresectable; 1 patient died during CRT of septic shock. Sixty-two of 75 remaining patients underwent pancreaticoduodenectomy. The overall median survival of all 102 patients in the study was 17 months, with a 5-year survival of 10%. For patients who underwent resection, the median survival was 23 months. Correspondingly, the median survival was 11 months for the 40 unresected patients (p = 0.002). The 5-year survivals for resected and unresected patients were 18 and 0% (p = 0.01), respectively. A complete pathological response to neoadjuvant CRT was noted for 8 patients (13%). Margin and lymph node positivity was present in 5 (8%) and 15 (24%) patients, respectively. There was documented local recurrence in 8 (13%) and distant recurrence in 36 (58%) patients, with the liver being the most common site.
Neoadjuvant 5-fluorouracil-based CRT had a limited impact on survival but appeared to be associated with improved local control.
本研究旨在评估接受新辅助5-氟尿嘧啶-顺铂同步放化疗（CRT）的Ⅰ/Ⅲ期胰腺腺癌患者的治疗结果。
符合条件的患者（n = 101）接受放射治疗（45 Gy），同时持续输注5-氟尿嘧啶并推注顺铂。
在纳入研究的102例患者中，26例患者在治疗期间出现癌症进展，被判定为不可切除；1例患者在CRT期间死于感染性休克。其余75例患者中有62例行胰十二指肠切除术。研究中所有102例患者的总中位生存期为17个月，5年生存率为10%。接受手术切除的患者中位生存期为23个月。相应地，40例未接受手术切除的患者中位生存期为11个月（p = 0.002）。接受手术切除和未接受手术切除患者的5年生存率分别为18%和0%（p = 0.01）。8例患者（13%）对新辅助CRT有完全病理反应。切缘阳性和淋巴结阳性分别见于5例（8%）和15例（24%）患者。有记录显示，8例（13%）患者出现局部复发，36例（58%）患者出现远处复发，肝脏是最常见的远处转移部位。
以5-氟尿嘧啶为基础的新辅助CRT对生存期的影响有限，但似乎与局部控制改善相关。
