Reboul F, Serin D, Martin D, Plat F
Département de cancérologie, clinique Sainte-Catherine, Avignon, France.
Bull Cancer. 1990;77(3):275-81.
Overall prognosis of pancreatic adenocarcinoma is still very poor with median survival around 10 months after radical surgery in operable patients, or after full-dose radiation therapy in non-surgical candidates. In metastatic disease, multidrug chemotherapy regimens give a response rate of around 30% with median survival of 10 months. Random trials conducted by the GITSG in inoperable cases have shown improved results for chemoradiation with 5-FU for radiotherapy alone and a doubling of median survival with a 1-year survival of 40% vs 10%. Incorporation of Adriamycin in these combined modality protocols does not improve the results in terms of survival. Chemoradiation also shows improved results compared with chemotherapy alone. In patients amenable to radical surgery, adjuvant post-operative treatment with chemoradiation gave superior results over surgery alone with a doubling of median survival and a significant improvement of a two-year survival rate (42% versus 15%). Intra-operative radiation therapy leads to better local control but without a significant improvement in survival. With a better understanding of radio-chemotherapy interactions and mechanisms of radiosensitization through continuous infusion of fluorouracil and/or cisplatinum, these encouraging results should be confirmed within the next few years.
胰腺癌的总体预后仍然很差，可手术患者根治性手术后的中位生存期约为10个月，不可手术患者接受全剂量放疗后的中位生存期也约为10个月。在转移性疾病中，多药化疗方案的缓解率约为30%，中位生存期为10个月。胃肠道肿瘤研究组（GITSG）在不可手术病例中进行的随机试验表明，与单纯放疗相比，5-氟尿嘧啶同步放化疗的效果有所改善，中位生存期翻倍，1年生存率从10%提高到40%。在这些综合治疗方案中加入阿霉素并不能提高生存率。与单纯化疗相比，同步放化疗也显示出更好的效果。对于适合根治性手术的患者，术后辅助放化疗的效果优于单纯手术，中位生存期翻倍，两年生存率显著提高（42%对15%）。术中放疗能更好地实现局部控制，但对生存率没有显著改善。随着对放化疗相互作用以及通过持续输注氟尿嘧啶和/或顺铂实现放射增敏机制的更好理解，这些令人鼓舞的结果有望在未来几年得到证实。
