Takahashi Shinichiro
Department of Hepato-biliary Pancreatic Surgery, National Cancer Center Hospital East, Chiba, Japan.
Jpn J Clin Oncol. 2018 Mar 1;48(3):205-213. doi: 10.1093/jjco/hyx191.
Borderline resectable pancreatic cancer (BRPC) is an advanced tumor in contact with the surrounding major vessels, making R0 resection difficult to achieve. Neoadjuvant treatment is expected to provide substantial local control and prolong survival. However, there is no standard treatment. I therefore conducted a strategic literature search from January 2013 to September 2017 and identified 37 clinical studies of pancreatic cancer, including BRPC, to evaluate treatment interventions. Twenty (54%) studies were prospective. Neoadjuvant regimens were as follows: chemotherapy (CT) followed by chemoradiotherapy (CRT) or radiotherapy (RT) (n = 16, 43%), CT alone (n = 11, 30%), CRT alone (n = 9, 24%) and RT alone (n = 1, 3%). Radiotherapy was employed in 70% of the studies. Phase II studies were most frequent (55%), and we were unable to identify a Phase III study. The National Comprehensive Cancer Network's classifications were most frequently used as criteria for BRPC, although resectability status is not standardized. Radiological central review was used in three of eight multi-institutional studies. Assessing on-going or planned clinical trials for BRPC, administration of oxaliplatin, irinotecan, fluorouracil and leucovorin therapy or albumin-bound paclitaxel plus gemcitabine therapy, and randomized trials that evaluate the significance of CRT or RT combined with CT were identified as important topics for further consideration. Although standardization of classifications and improvement of infrastructure are required, a standard treatment of BRPC will likely be developed, which will improve prognosis in the near future because several important randomized trials are running.
可切除边缘的胰腺癌（BRPC）是一种与周围主要血管相邻的晚期肿瘤，使得R0切除难以实现。新辅助治疗有望实现有效的局部控制并延长生存期。然而，目前尚无标准治疗方案。因此，我在2013年1月至2017年9月期间进行了一项策略性文献检索，确定了37项包括BRPC在内的胰腺癌临床研究，以评估治疗干预措施。其中20项（54%）研究为前瞻性研究。新辅助治疗方案如下：化疗（CT）后序贯放化疗（CRT）或放疗（RT）（n = 16，43%）、单纯CT（n = 11，30%）、单纯CRT（n = 9，24%）以及单纯RT（n = 1，3%）。70%的研究采用了放疗。II期研究最为常见（55%），且我们未找到III期研究。尽管可切除状态尚未标准化，但美国国立综合癌症网络的分类最常被用作BRPC的标准。八项多机构研究中有三项采用了影像学中心审查。评估BRPC正在进行或计划开展的临床试验时，奥沙利铂、伊立替康、氟尿嘧啶和亚叶酸钙联合治疗或白蛋白结合型紫杉醇加吉西他滨治疗的应用，以及评估CRT或RT联合CT意义的随机试验被确定为需要进一步考虑的重要课题。尽管需要对分类进行标准化并改善基础设施，但BRPC的标准治疗方案可能会得以制定，鉴于目前有几项重要的随机试验正在进行，这将在不久的将来改善预后。
