Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Unit 1484, Houston, TX, 77030-1402, USA.
J Gastrointest Surg. 2021 Mar;25(3):843-848. doi: 10.1007/s11605-020-04838-6. Epub 2020 Nov 17.
The role of (chemo) radiation in the perioperative management of patients with resectable and borderline resectable pancreatic ductal adenocarcinoma is controversial. Herein, we review and interpret existing data relating to the ability of (chemo) radiation to "downstage" pancreatic tumors, delay recurrence, and prolong patients' survival. In sum, the evidence suggests that while neoadjuvant (chemo) radiation may impact pathologic metrics favorably, it rarely converts anatomically unresectable tumors to resectable ones. And while data do support the ability of (chemo)radiation to delay cancer progression, its ability to prolong longevity has not been confirmed. It is possible that (chemo)radiation is effective in prolonging the survival of select patients, but to date, this cohort remains undefined due to heterogeneity in both the populations studied and the regimens used to treat them. Based on our interpretation of existing data, we currently administer neoadjuvant and adjuvant (chemo)radiation selectively to patients with localized pancreatic cancer who we consider at highest risk for local progression. We may also use it as an alternative to pancreatectomy in patients who are poor candidates for surgery. Ultimately, the role of (chemo)radiation in these settings is evolving. Better studies of patients most likely to benefit from its local effects are necessary to clearly define its place within the perioperative treatment algorithms used for patients with localized pancreatic cancer.
在可切除和边界可切除的胰腺导管腺癌患者的围手术期管理中，（化疗）放疗的作用存在争议。在此，我们回顾和解释了与（化疗）放疗使胰腺肿瘤“降级”、延缓复发和延长患者生存时间的能力相关的现有数据。总之，证据表明，虽然新辅助（化疗）放疗可能对病理指标有有利影响，但很少能将解剖学上不能切除的肿瘤转化为可切除的肿瘤。虽然数据确实支持（化疗）放疗有延缓癌症进展的能力，但它延长寿命的能力尚未得到证实。（化疗）放疗可能对某些患者的生存延长有效，但迄今为止，由于研究人群和治疗方案的异质性，这一队列仍然没有明确界定。基于我们对现有数据的解释，我们目前选择性地向局部胰腺癌患者提供新辅助和辅助（化疗）放疗，我们认为这些患者有发生局部进展的最高风险。对于那些不适合手术的患者，我们也可能将其作为手术的替代方法。最终，（化疗）放疗在这些情况下的作用仍在发展中。需要对最有可能从其局部效果中获益的患者进行更好的研究，以明确其在用于局部胰腺癌患者的围手术期治疗方案中的地位。
