Sohal Davendra P S, Willingham Field F, Falconi Massimo, Raphael Kara L, Crippa Stefano
From the Cleveland Clinic, Cleveland, OH; Emory University School of Medicine, Atlanta, GA; Division of Pancreatic Surgery, Università Vita-Salute, San Raffaele Scientific Institute, Milan, Italy.
Am Soc Clin Oncol Educ Book. 2017;37:301-310. doi: 10.1200/EDBK_175222.
Pancreatic cancer is a growing problem in oncology, given slowly rising incidence and continued suboptimal outcomes. A concerted effort to reverse this tide will require prevention, early diagnosis, and improved systemic therapy for curable disease. We focus on these aspects in detail in this study. Hereditary pancreatic cancer is an underappreciated area. With the growing use of genomics (both somatic and germline) in cancer care, there is increasing recognition of hereditary pancreatic cancer cases: around 10% of all pancreatic cancer may be related to familial syndromes, such as familial atypical multiple mole and melanoma (FAMMM) syndrome, hereditary breast and ovarian cancer, Lynch syndrome, and Peutz-Jeghers syndrome. Screening and surveillance guidelines by various expert groups are discussed. Management of resectable pancreatic cancer is evolving; the use of multiagent systemic therapies, in the adjuvant and neoadjuvant settings, is discussed. Current and emerging data, along with ongoing clinical trials addressing important questions in this area, are described. Surveillance recommendations based on latest ASCO guidelines are also discussed. Finally, the multimodality management of borderline resectable pancreatic cancer is discussed. The various clinicoanatomic definitions of this entity, followed by consensus definitions, are described. Then, we focus on current opinions and practices around neoadjuvant therapy, discussing chemotherapy and radiation aspects, and the role of surgical resection.
鉴于胰腺癌的发病率在缓慢上升且治疗效果仍不尽人意，它已成为肿瘤学领域日益严峻的问题。要扭转这一趋势，需要共同努力做好预防、早期诊断以及改善可治愈疾病的全身治疗。在本研究中，我们将详细关注这些方面。遗传性胰腺癌是一个未得到充分重视的领域。随着基因组学（包括体细胞和生殖系）在癌症治疗中的应用日益广泛，人们对遗传性胰腺癌病例的认识不断提高：所有胰腺癌病例中约10%可能与家族综合征有关，如家族性非典型多发性痣和黑色素瘤（FAMMM）综合征、遗传性乳腺癌和卵巢癌、林奇综合征以及佩-杰综合征。本文讨论了各专家组的筛查和监测指南。可切除胰腺癌的治疗方法在不断发展；文中讨论了多药全身治疗在辅助和新辅助治疗中的应用。描述了当前和新出现的数据，以及针对该领域重要问题正在进行的临床试验。还讨论了基于美国临床肿瘤学会（ASCO）最新指南的监测建议。最后，讨论了临界可切除胰腺癌的多模式治疗。描述了该实体的各种临床解剖学定义，随后给出了共识定义。然后，我们重点关注围绕新辅助治疗的当前观点和实践，讨论化疗和放疗方面以及手术切除的作用。
