Department of Radiation Oncology, John Paul II Center for High Technology Research and Education in Biomedical Sciences, Catholic University, Campobasso, Italy.
Ann Surg Oncol. 2010 Jan;17(1):194-205. doi: 10.1245/s10434-009-0762-4. Epub 2009 Oct 24.
The objective of this study was to determine the effect on resection rate and survival of neoadjuvant chemoradiotherapy for primarily unresectable locally advanced pancreatic carcinoma.
A systematic review of recently published literature was performed. Resection rates and survival data were derived from reports published from 2000 onwards. Only recent studies, based on radiotherapy with standard dose and fractionation, have been analyzed.
Thirteen studies with a total of 510 patients met selection criteria. A resection rate of 8.3-64.2% was reported (median, 26.5%). Of the operated patients, 57.1-100% (median, 87.5%) had R0 tumor resection. Most papers reported occasional pathological complete responses (CR, 3.0-8.8%). When outcome in all patients was considered, median survival ranged from 9 to 23 (median, 13.3) months, comparing favorably with literature data based on concurrent chemoradiation alone (range, 8.6-13 months). Surprisingly, in patients with unresectable tumor at presentation, median survival after surgery ranged from 16.4 to 32.3 (median, 23.6) months.
The finding of a high proportion of R0 resection among all resections performed confirms the activity of neoadjuvant radiochemotherapy and should not be neglected. Based on these data, patients with unresectable pancreatic cancer without disease progression after chemoradiotherapy should be considered for radical surgery.
本研究旨在确定新辅助放化疗对不可切除的局部晚期胰腺癌的切除率和生存率的影响。
对最近发表的文献进行系统回顾。从 2000 年以后发表的报告中得出切除率和生存数据。仅分析了基于标准剂量和分割放疗的最近研究。
符合选择标准的有 13 项研究，共 510 例患者。报告的切除率为 8.3-64.2%（中位数为 26.5%）。在接受手术的患者中，57.1-100%（中位数为 87.5%）行 R0 肿瘤切除。大多数论文报告偶尔出现病理完全缓解（CR，3.0-8.8%）。当考虑所有患者的结局时，中位生存期从 9 至 23 个月不等（中位数为 13.3 个月），与单纯同期放化疗的文献数据（8.6-13 个月）相比有优势。令人惊讶的是，在初诊时肿瘤不可切除的患者中，手术后的中位生存期从 16.4 至 32.3 个月不等（中位数为 23.6 个月）。
所有行切除术患者中 R0 切除率高的发现证实了新辅助放化疗的活性，不应被忽视。基于这些数据，在放化疗后无疾病进展的不可切除胰腺癌患者应考虑行根治性手术。
