Huguet F, Orthuon A, Touboul E, Marseguerra R, Mornex F
Service d'oncologie radiothérapie, hôpital Tenon, Assistance-Publique-Hôpitaux de Paris, Université Paris VI, 4, rue de la Chine, 75020 Paris, France.
Cancer Radiother. 2010 Nov;14 Suppl 1:S94-102. doi: 10.1016/S1278-3218(10)70012-3.
About 7200 new cases of pancreatic adenocarcinomas are diagnosed each year in France. At the time of diagnosis, an efficient carcinologic surgery will not be possible for nearly 80% of patients, in relation to loco-regional extension or metastatic dissemination. After surgical resection, the median survival of resected patients ranges from 12 to 20 months, with a high rate of relapses. Currently, the use of radiotherapy for patients with pancreatic cancer is controversial. In adjuvant setting, the standard treatment is six months of chemotherapy with FUFOL or gemcitabine. Chemoradiation (CRT) may improve the survival of patients with incompletely resected tumors (R1). This must be validated in a prospective trial. Neoadjuvant CRT is a promising treatment but always under evaluation. For the treatment of patients with locally advanced tumors, there is not a standart treatment. A strategy of initial chemotherapy followed by CRT for non progressive patients is under evaluation. Whereas in the first trials of CRT large fields were used, the current trend is to reduce the treated volumes to improve tolerance. The delineation of target volumes has been improved by the use of simulation CT. The aims of this work are to precise the radio-anatomical particularities, the pattern of spread of pancreatic cancer and the principles of 3D conformal radiotherapy illustrated with a clinical case.
法国每年约有7200例新诊断的胰腺腺癌病例。在诊断时,由于局部区域扩展或远处转移,近80%的患者无法进行有效的肿瘤切除手术。手术切除后,接受手术患者的中位生存期为12至20个月,复发率很高。目前,胰腺癌患者使用放疗存在争议。在辅助治疗中,标准治疗是使用氟尿嘧啶/亚叶酸或吉西他滨进行六个月的化疗。放化疗(CRT)可能会提高肿瘤切除不完全(R1)患者的生存率。这必须在前瞻性试验中得到验证。新辅助CRT是一种有前景的治疗方法,但仍在评估中。对于局部晚期肿瘤患者的治疗,没有标准治疗方案。一种先进行初始化疗,然后对病情无进展的患者进行CRT的策略正在评估中。在CRT的最初试验中使用的是大野放疗,而目前的趋势是缩小治疗体积以提高耐受性。通过使用模拟CT,靶区体积的勾画得到了改善。这项工作的目的是明确放射解剖学特点、胰腺癌的扩散模式以及通过一个临床病例说明三维适形放疗的原则。