Backlund Dana C, Berlin Jordan D, Parikh Alexander A
Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, 777 Preston Research Building, 2220 Pierce Avenue, Nashville, TN 37232, USA.
Surg Oncol Clin N Am. 2010 Apr;19(2):391-409. doi: 10.1016/j.soc.2009.11.003.
Adjuvant therapy for pancreatic cancer remains a controversial topic, with a paucity of randomized controlled trials in this area and various limitations in the trials that have been conducted to date, leaving many questions as to a true "standard of care" for patients with resectable or potentially resectable disease. Several large and well-conducted phase 3 trials have reported results recently and have helped to solidify the role of chemotherapy, with either 5-fluorouracil or gemcitabine, as an effective intervention in the adjuvant setting. The role of radiotherapy remains unclear, but it does seem to be feasible and safe, and there are trials in development that may shed more light on this question. Many small trials have pointed to the potential utility of neoadjuvant strategies in selecting the patients who are most likely to benefit from surgery and in improving outcomes by providing systemic therapy early on. Larger trials are ongoing in hopes that they will give more definitive answers as to when this strategy should be used. It is hoped that trials using novel agents, either alone or in combination with more traditional therapies, will better define the best strategy for improving outcomes in patients with resectable disease.
胰腺癌的辅助治疗仍然是一个有争议的话题，该领域缺乏随机对照试验，且迄今为止所开展的试验存在各种局限性，这使得对于可切除或潜在可切除疾病患者的真正“标准治疗方案”存在诸多疑问。最近，几项大型且开展良好的3期试验报告了结果，这有助于巩固以5-氟尿嘧啶或吉西他滨进行化疗作为辅助治疗有效干预措施的作用。放疗的作用仍不明确，但似乎可行且安全，并且正在开展的试验可能会进一步阐明这个问题。许多小型试验表明，新辅助治疗策略在选择最有可能从手术中获益的患者以及通过早期提供全身治疗改善预后方面具有潜在效用。正在进行更大规模的试验，希望能就何时应采用这一策略给出更明确的答案。人们希望使用新型药物的试验，无论是单独使用还是与更传统的疗法联合使用，将能更好地确定改善可切除疾病患者预后的最佳策略。
