吉西他滨新辅助放化疗治疗局部进展期胰腺癌。

Neoadjuvant chemoradiation with Gemcitabine for locally advanced pancreatic cancer.

机构信息

Department of Radiation Oncology, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.

出版信息

Radiat Oncol. 2012 Mar 2;7:28. doi: 10.1186/1748-717X-7-28.

DOI:10.1186/1748-717X-7-28

PMID:22385572

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3338091/

Abstract

INTRODUCTION

To evaluate efficacy and secondary resectability in patients with locally advanced pancreatic cancer (LAPC) treated with neoadjuvant chemoradiotherapy (CRT).

PATIENTS AND METHODS

A total of 215 patients with locally advanced pancreatic cancer were treated with chemoradiation at a single institution. Radiotherapy was delivered with a median dose of 52.2 Gy in single fractions of 1.8 Gy. Chemotherapy was applied concomitantly as gemcitabine (GEM) at a dose of 300 mg/m2 weekly, followed by adjuvant cycles of full-dose GEM (1000 mg/m2). After neoadjuvant CRT restaging was done to evaluate secondary resectability. Overall and disease-free survival were calculated and prognostic factors were estimated.

RESULTS

After CRT a total of 26% of all patients with primary unresectable LAPC were chosen to undergo secondary resection. Tumour free resection margins could be achieved in 39.2% (R0-resection), R1-resections were seen in 41.2%, residual macroscopic tumour in 11.8% (R2) and in 7.8% resection were classified as Rx. Patients with complete resection after CRT showed a significantly increased median overall survival (OS) with 22.1 compared to 11.9 months in non-resected patients. Median OS and disease-free survival (DFS) of all patients were 12.3 and 8.1 months respectively. In most cases the first site of disease progression was systemic with hepatic (52%) and peritoneal (36%) metastases.

DISCUSSION

A high percentage of patients with locally advanced pancreatic cancer can undergo secondary resection after gemcitabine-based chemoradiation and has a relative long-term prognosis after complete resection.

摘要

介绍

评估新辅助放化疗（CRT）治疗局部晚期胰腺癌（LAPC）患者的疗效和二次可切除性。

患者和方法

在一家机构中，共有 215 名局部晚期胰腺癌患者接受了放化疗。放疗采用中位数剂量为 52.2 Gy 的单次分割 1.8 Gy。化疗同时应用吉西他滨（GEM），剂量为 300 mg/m2 每周，随后进行全剂量 GEM（1000 mg/m2）辅助周期。新辅助 CRT 后进行再分期，以评估二次可切除性。计算总生存期和无病生存期，并评估预后因素。

结果

在 CRT 后，共有 26%的原发不可切除的 LAPC 患者选择进行二次切除。肿瘤无残留的切除边缘率为 39.2%（R0 切除），R1 切除率为 41.2%，残留肉眼肿瘤的切除率为 11.8%（R2），7.8%的切除被归类为 Rx。CRT 后完全切除的患者中位总生存期（OS）明显延长，为 22.1 个月，而非切除患者为 11.9 个月。所有患者的中位 OS 和无病生存期（DFS）分别为 12.3 个月和 8.1 个月。在大多数情况下，疾病进展的第一个部位是全身性的，肝转移（52%）和腹膜转移（36%）。