Division of Hematology and Medical Oncology.
Cancer Care Specialists of Illinois.
Am J Clin Oncol. 2020 Jun;43(6):435-441. doi: 10.1097/COC.0000000000000688.
Pancreatic ductal adenocarcinoma is a largely incurable cancer. Surgical resection remains the only potential option for cure. Even in surgically resectable patients, only about 10% to 20% are long-term survivors. Emerging data suggest a role for neoadjuvant therapy to target occult micrometastatic disease.
To report our institutional experience with a novel neoadjuvant chemoradiation (CRT) regimen in resectable and borderline resectable pancreatic cancer.
Patients were treated with 2 cycles of induction chemotherapy with FOLFOX and then received CRT with gemcitabine and intensity-modulated radiotherapy (IMRT).
From April 2014 to June 2017, 24 patients were enrolled. Eighteen patients were borderline resectable and 6 patients were resectable. All patients received induction chemotherapy with FOLFOX. Thirteen patients underwent pancreatectomy after CRT with a resection rate of 62%. R0 resection achieved in 11 patients (84.6%) and 2 patients had R1 resection (15.4%). For patients who underwent resection, the median progression-free survival (PFS) was 31 months, 1-year PFS rate was 69.2% (95% confidence interval [CI], 0.48-0.99), and 2-year PFS rate was 51.9% (95% CI, 0.3-0.89). Median overall survival (OS) was 34.8 months (95% CI, 1.045 to infinity), 1-year OS rate was 91.7% (95% CI, 0.77-1.0), and 2-year OS rate was 75% (95% CI, 0.54-1.0). Median CA 19-9 at screening for patients who underwent surgery was 659 (range, 18 to 2154), which decreased to 146.9 (range, 18 to 462) after CRT before resection.
Neoadjuvant therapy for borderline resectable and resectable pancreatic ductal adenocarcinoma with CRT facilitated R0 resection in 84% patients who underwent surgery.
胰腺导管腺癌是一种基本无法治愈的癌症。手术切除仍然是唯一可能治愈的方法。即使在可手术切除的患者中，也只有约 10%至 20%是长期幸存者。新出现的数据表明，新辅助治疗在针对隐匿性微转移疾病方面具有作用。
报告我们机构在可切除和交界可切除胰腺导管腺癌中使用新辅助化疗放疗（CRT）方案的经验。
患者接受 2 个周期的 FOLFOX 诱导化疗，然后接受吉西他滨和调强放疗（IMRT）的 CRT。
从 2014 年 4 月至 2017 年 6 月，共纳入 24 例患者。18 例为交界可切除，6 例为可切除。所有患者均接受 FOLFOX 诱导化疗。13 例患者在 CRT 后接受胰切除术，切除率为 62%。RO 切除 11 例（84.6%），2 例 R1 切除（15.4%）。对于接受切除术的患者，中位无进展生存期（PFS）为 31 个月，1 年 PFS 率为 69.2%（95%可信区间 [CI]，0.48-0.99），2 年 PFS 率为 51.9%（95% CI，0.3-0.89）。中位总生存期（OS）为 34.8 个月（95% CI，1.045 至无穷大），1 年 OS 率为 91.7%（95% CI，0.77-1.0），2 年 OS 率为 75%（95% CI，0.54-1.0）。接受手术的患者术前 CA19-9 筛查中位数为 659（范围为 18 至 2154），CRT 后降为 146.9（范围为 18 至 462）。
对于交界可切除和可切除的胰腺导管腺癌，新辅助 CRT 治疗可使 84%接受手术的患者获得 RO 切除。
Zotero 插件