Ambe Chenwi M, Nguyen Phuong, Centeno Barbara A, Choi Junsung, Strosberg Jonathan, Kvols Larry, Hodul Pamela, Hoffe Sarah, Malafa Mokenge P
1 Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
2 Department of Anatomic Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
Cancer Control. 2017 Oct-Dec;24(5):1073274817729076. doi: 10.1177/1073274817729076.
Pancreatic neuroendocrine tumors (PanNETs) constitute approximately 3% of pancreatic neoplasms. Like patients with pancreatic ductal adenocarcinoma (PDAC), some of these patients present with "borderline resectable disease." For these patients, an optimal treatment approach is lacking. We report our institution's experience with borderline resectable PanNETs using multimodality treatment.
We identified patients with borderline resectable PanNETs who had received neoadjuvant therapy at our institution between 2000 and 2013. The definition of borderline resectability was based on National Comprehensive Cancer Network criteria for PDAC. Neoadjuvant regimen, radiographic response, pathologic response, surgical margins, nodal retrieval, number of positive nodes, and recurrence were documented. Statistics were descriptive.
Of 112 patients who underwent surgical resection for PanNETs during the study period, 23 received neoadjuvant therapy, 6 of whom met all inclusion criteria and had borderline resectable disease. These 6 patients received at least 1 cycle of temozolomide and capecitabine, with 3 also receiving radiation. All had radiographic evidence of treatment response. Four (67%) had negative-margin resections. Four patients had histologic evidence of a moderate response. Follow-up (3.0-4.3 years) indicated that all patients were alive, with 5/6 free of disease (1 patient with metastatic disease still on treatment without progression).
A multimodality treatment strategy (neoadjuvant temozolomide and capecitabine ± radiation) can be successfully applied to patients with PanNETs who meet NCCN borderline resectable criteria for PDAC. To our knowledge, this is the first report of the use of a multimodality protocol in the treatment of patients with borderline resectable PanNETs.
胰腺神经内分泌肿瘤（PanNETs）约占胰腺肿瘤的3%。与胰腺导管腺癌（PDAC）患者一样，其中一些患者表现为“可切除边缘性疾病”。对于这些患者，缺乏最佳的治疗方法。我们报告了我们机构使用多模式治疗可切除边缘性PanNETs的经验。
我们确定了2000年至2013年间在我们机构接受新辅助治疗的可切除边缘性PanNETs患者。可切除边缘性的定义基于美国国立综合癌症网络（NCCN）的PDAC标准。记录新辅助治疗方案、影像学反应、病理反应、手术切缘、淋巴结清扫情况、阳性淋巴结数量和复发情况。统计数据为描述性的。
在研究期间接受PanNETs手术切除的112例患者中，23例接受了新辅助治疗，其中6例符合所有纳入标准且患有可切除边缘性疾病。这6例患者接受了至少1个周期的替莫唑胺和卡培他滨治疗，3例还接受了放疗。所有患者均有治疗反应的影像学证据。4例（67%）患者切缘阴性。4例患者有中度反应的组织学证据。随访（3.0 - 4.3年）表明所有患者均存活，6例中有5例无疾病（1例转移性疾病患者仍在接受治疗且无进展）。
多模式治疗策略（新辅助替莫唑胺和卡培他滨±放疗）可成功应用于符合NCCN PDAC可切除边缘性标准的PanNETs患者。据我们所知，这是首次报道使用多模式方案治疗可切除边缘性PanNETs患者。
