Huang Xiaolun, Knoble Jeanna L, Zeng Ming, Aguila Fernando N, Patel Tara, Chambers Lowell W, Hu Honglin, Liu Hao
Department of Hepatobiliary-Pancreatic Surgery and Cell Transplant Center, the Affiliated Hospital of University of Electronic Science and Technology, Chengdu, Sichuan, China.
Department of Hematology and Oncology, Zangmeister Cancer Center, Mount Carmel Health System, Columbus, Ohio, United States of America.
PLoS One. 2016 Dec 9;11(12):e0166606. doi: 10.1371/journal.pone.0166606. eCollection 2016.
To study the feasibility of down stage the borderline resectable pancreatic cancer (BRPC) to resectable disease, we reported our institutional results using an intensity-modulated radiation therapy (IMRT) simultaneous integrated boost (SIB) dose escalation approach to improve R0 resectability.
We reviewed our past 7 years of experience of using neoadjuvant induction chemotherapy with Gemcitabine followed by concurrent chemoradiaiton for BRPC. During the concurrent, chemo was 5-FU and radiation were IMRT with SIB technique to target the key areas with dose escalation to 5600 in 28 fractions. The key areas were defined by PET positive area. This was followed by restaging imaging to rule out distant metastases before resection.
25 finished dose escalation protocol. 2 of the 25 cases developed distant metastases, 23 (92%) patients without distant metastases underwent pancreatectomy. Among the those received pancreatectomy, 22 (95%) achieved negative margin (R0). The gastrointestinal toxicity > grade 2 was 8% and there was no grade 4 toxicity.
Neoadjuvant Gemcitabine-based induction chemotherapy followed by 5-FU-based IMRT-SIB is a feasible option in improving the likelihood of R0 resection rate in BRPC without compromising the organs at risk for toxicity.
为研究将临界可切除胰腺癌（BRPC）降期为可切除疾病的可行性，我们报告了我们机构采用调强放射治疗（IMRT）同步整合加量（SIB）剂量递增方法以提高R0切除率的结果。
我们回顾了过去7年使用吉西他滨进行新辅助诱导化疗，随后对BRPC进行同步放化疗的经验。在同步放化疗期间，化疗药物为5-氟尿嘧啶（5-FU），放疗采用IMRT-SIB技术，针对关键区域进行剂量递增至5600 cGy，分28次照射。关键区域由PET阳性区域定义。在切除术前进行重新分期影像学检查以排除远处转移。
25例完成了剂量递增方案。25例中有2例发生远处转移，23例（92%）无远处转移的患者接受了胰腺切除术。在接受胰腺切除术的患者中，22例（95%）切缘阴性（R0）。胃肠道毒性>2级的发生率为8%，无4级毒性。
以吉西他滨为基础的新辅助诱导化疗后序贯以5-FU为基础的IMRT-SIB是提高BRPC患者R0切除率可能性的可行选择，且不会增加毒性风险器官的损伤。
