Miller Robert C, Iott Matthew J, Corsini Michele M
Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Int J Radiat Oncol Biol Phys. 2009 Oct 1;75(2):364-8. doi: 10.1016/j.ijrobp.2008.11.069.
To present an overview of Phase III trials in adjuvant therapy for pancreatic cancer and review outcomes at the Mayo Clinic after adjuvant radiochemotherapy (RT/CT) for resected pancreatic cancer.
A literature review and a retrospective review of 472 patients who underwent an R0 resection for T1-3N0-1M0 invasive carcinoma of the pancreas from 1975 to 2005 at the Mayo Clinic, Rochester, MN. Patients with metastatic or unresectable disease at the time of surgery, positive surgical margins, or indolent tumors and those treated with intraoperative radiotherapy were excluded from the analysis. Median radiotherapy dose was 50.4 Gy in 28 fractions, with 98% of patients receiving concurrent 5-fluorouracil- based chemotherapy.
Median follow-up was 2.7 years. Median overall survival (OS) was 1.8 years. Median OS after adjuvant RT/CT was 2.1 vs. 1.6 years for surgery alone (p = 0.001). The 2-y OS was 50% vs. 39%, and 5-y was 28% vs. 17% for patients receiving RT/CT vs. surgery alone. Univariate and multivariate analysis revealed that adverse prognostic factors were positive lymph nodes (risk ratio [RR] 1.3, p < 0.001) and high histologic grade (RR 1.2, p < 0.001). T3 tumor status was found significant on univariate analysis only (RR 1.1, p = 0.07).
Results from recent clinical trials support the use of adjuvant chemotherapy in resected pancreatic cancer. The role of radiochemotherapy in adjuvant treatment of pancreatic cancer remains a topic of debate. Results from the Mayo Clinic suggest improved outcomes after the administration of adjuvant radiochemotherapy after a complete resection of invasive pancreatic malignancies.
概述胰腺癌辅助治疗的III期试验，并回顾梅奥诊所对可切除胰腺癌进行辅助放化疗（RT/CT）后的结果。
对1975年至2005年在明尼苏达州罗切斯特市梅奥诊所接受R0切除的472例T1-3N0-1M0胰腺浸润性癌患者进行文献回顾和回顾性分析。手术时伴有转移或不可切除疾病、手术切缘阳性、肿瘤生长缓慢的患者以及接受术中放疗的患者被排除在分析之外。中位放疗剂量为50.4 Gy，分28次给予，98%的患者同时接受基于5-氟尿嘧啶的化疗。
中位随访时间为2.7年。中位总生存期（OS）为1.8年。辅助RT/CT后的中位OS为2.1年，单纯手术为1.6年（p = 0.001）。接受RT/CT与单纯手术的患者，2年OS分别为50%和39%，5年OS分别为28%和17%。单因素和多因素分析显示，不良预后因素为淋巴结阳性（风险比[RR] 1.3，p < 0.001）和高组织学分级（RR 1.2，p < 0.001）。仅在单因素分析中发现T3肿瘤状态具有显著性（RR 1.1，p = 0.07）。
近期临床试验结果支持在可切除胰腺癌中使用辅助化疗。放化疗在胰腺癌辅助治疗中的作用仍是一个有争议的话题。梅奥诊所的结果表明，在完全切除浸润性胰腺恶性肿瘤后给予辅助放化疗可改善预后。
