Ulm University Hospital Medical Center, Department of Internal Medicine I, Medical Clinic III, Department of Hematology & Oncology, Großhadern Hospital, Ludwig-Maximilian-¬Universität, Munich, Institute of Pathology, Ruhr-University Bochum, Radiation and Tumor Clinic, University Hospital of Duisburg-Essen, Surgical Clinic at the St. Josef-Hospital, Ruhr-University Bochum.
Dtsch Arztebl Int. 2014 May 30;111(22):396-402. doi: 10.3238/arztebl.2014.0396.
Ductal adenocarcinoma of the pancreas is the fourth most common cause of death from cancer in men and women in Germany: about 15 000 persons die of this disease each year.
The S3 guideline on exocrine pancreatic carcinoma was updated with the aid of systematic literature reviews on the surgical, neoadjuvant, and adjuvant treatment of ductal pancreatic carcinoma, and on treatment in the metastatic stage. These reviews covered the periods 2002 to February 2012 (for radiotherapy) and 2006 to August 2011 (for all other topics).
The criteria for borderline resectable pancreatic tumors are the same as those of the guidelines of the National Comprehensive Cancer Network. Preoperative biliary drainage with a stent is recommended only if cholangitis is present or if a planned operation cannot be performed soon after the diagnosis is made. When a pancreatic carcinoma is resected, at least 10 regional lymph nodes should be excised, and the ratio of affected to excised nodes should be documented in the pathology report. Gemcitabine and 5-fluorouracil are recommended for adjuvant therapy. Neither of these drugs is preferred over the other; if the one initially given is poorly tolerated, the other one should be given instead. When gemcitabine and erlotinib are given for palliative treatment, erlotinib should be given for no longer than 8 weeks if no skin rash develops. In selected patients, the folfirinox protocol yields markedly better results than gemcitabin. Moreover, the new combination of nab-paclitaxel and gemcitabine can be used as first-line treatment. In the event of disease progression under first-line treatment, second-line treatment should be initiated.
In recent years, new chemotherapeutic protocols have brought about marked improvement in palliative care. Further trials are needed to determine whether the perioperative or adjuvant use of these protocols might also improve the outcome of surgical treatment with curative intent.
在德国，男性和女性因癌症死亡的第四大常见原因是胰腺导管腺癌：每年约有 15000 人死于这种疾病。
在外分泌胰腺肿瘤 S3 指南中，借助于对胰腺导管腺癌的手术、新辅助和辅助治疗以及转移阶段治疗的系统文献综述进行了更新。这些综述涵盖了 2002 年至 2012 年 2 月（用于放疗）和 2006 年至 2011 年 8 月（用于所有其他主题）的时间段。
边界可切除胰腺肿瘤的标准与国家综合癌症网络指南的标准相同。仅当存在胆管炎或在诊断后不久无法进行计划手术时，才建议进行术前支架胆道引流。当切除胰腺癌时，至少应切除 10 个区域淋巴结，并且应在病理报告中记录受影响与切除淋巴结的比例。建议进行吉西他滨和氟尿嘧啶辅助治疗。这两种药物均不优于另一种药物；如果最初给予的药物耐受性差，则应改用另一种药物。当吉西他滨和厄洛替尼用于姑息治疗时，如果没有皮疹，则厄洛替尼的使用时间不应超过 8 周。在选择的患者中，Folfirinox 方案的效果明显优于吉西他滨。此外，nab-紫杉醇和吉西他滨的新组合可作为一线治疗。在一线治疗中疾病进展时，应开始二线治疗。
近年来，新的化疗方案在姑息治疗方面带来了显著改善。需要进一步的试验来确定这些方案是否可以在围手术期或辅助使用，也可能改善具有治愈意图的手术治疗的结果。
