Hepatobiliary and Surgical Oncology Unit, University of New South Wales, Department of Surgery, St George Hospital, Kogarah, NSW 2217, Sydney, Australia.
Surg Oncol. 2011 Dec;20(4):e161-8. doi: 10.1016/j.suronc.2011.05.003. Epub 2011 Jun 24.
There has been an interest in the interdisciplinary and multimodality approach that combines chemotherapy and radiation therapy as a preoperative treatment for patients with resectable pancreatic cancer.
Literature search of databases (Medline and PubMed) to identify published studies of preoperative chemoradiation for resectable pancreatic cancer (potentially resectable and borderline resectable) was undertaken. Response to treatment and survival outcomes was examined as endpoints of this review.
Seventeen studies; eight phase II studies, and nine observational studies, comprising of 977 patients were reviewed. Gemcitabine-based chemotherapy with radiotherapy was the most common preoperative regimen. Following preoperative treatment, pancreatic surgical resection was performed in 35-100% (median=61%) of patients after a range of 6-32 weeks (median=7 weeks). Rate of pathological response was complete in 5-15% of patients, partial in 33-60% and minimal in 38-42%. The median overall survival ranged from 12 months to 40 months (median=25 months) with a 5-year overall survival rate ranging between 8% and 36% (median=28%). Patients who underwent chemoradiation but did not undergo surgery survived a median period of 7-11 months (median=9 months).
Preoperative gemcitabine-based chemoradiation followed by restaging and surgical evaluation for pancreatic resection may identify a sub-population of patients with resectable disease who would benefit the most from surgery. Investigation of this schema of preoperative therapy in a randomized setting of resectable pancreatic cancer is warranted.
人们对化疗和放疗相结合的多学科、多模态方法感兴趣，将其作为可切除胰腺癌患者的术前治疗。
对数据库（Medline 和 PubMed）中的文献进行检索，以确定可切除胰腺癌（潜在可切除和边缘可切除）术前放化疗的已发表研究。将治疗反应和生存结果作为本综述的终点进行检查。
共审查了 17 项研究；8 项 II 期研究和 9 项观察性研究，共纳入 977 例患者。以吉西他滨为基础的化疗联合放疗是最常见的术前方案。经过术前治疗，在 6-32 周（中位 7 周）后，有 35-100%（中位 61%）的患者接受了胰腺外科切除术。病理反应完全的患者比例为 5-15%，部分反应的患者比例为 33-60%，最小反应的患者比例为 38-42%。中位总生存期从 12 个月到 40 个月不等（中位 25 个月），5 年总生存率在 8%-36%之间（中位 28%）。未接受手术的接受放化疗的患者中位生存期为 7-11 个月（中位 9 个月）。
术前以吉西他滨为基础的放化疗，然后进行重新分期和手术评估以确定是否可进行胰腺切除术，可能会确定一个最受益于手术的可切除疾病亚人群。在可切除胰腺癌的随机研究中，有必要对这种术前治疗方案进行研究。
