局部进展期不可切除和交界可切除胰腺癌的新辅助治疗：单中心的肿瘤学结果。
Neoadjuvant treatment for locally advanced unresectable and borderline resectable pancreatic cancer: oncological outcomes at a single academic centre.
机构信息
Medical Oncology, Biomedical Research Institute INCLIVA. Hospital Clínico Universitario, Valencia, Spain; CIBERONC, Instituto de Salud Carlos III, Madrid, Comunidad de Madrid, Spain.
Oncology Unit, Oncology Department, ASST di Cremona, Ospedale di Cremona, Cremona, Italy.
出版信息
ESMO Open. 2020 Nov;5(6):e000929. doi: 10.1136/esmoopen-2020-000929.
INTRODUCTION
Pancreatic cancer (PC), even in the absence of metastatic disease, has a dismal prognosis. One-third of them are borderline resectable (BRPC) or locally advanced unresectable PC (LAUPC) at diagnosis. There are limited prospective data supporting the best approach on these tumours. Neoadjuvant chemotherapy (ChT) is being increasingly used in this setting.
METHODS
This is a retrospective series of consecutive patients staged as BRPC or LAUPC after discussion in the multidisciplinary board (MDB) at an academic centre. All received neoadjuvant ChT, followed by chemoradiation (ChRT) in some cases, and those achieving enough downstaging had a curative-intent surgery. Descriptive data about patient's characteristics, neoadjuvant treatments, toxicities, curative resections, postoperative complications, pathology reports and adjuvant treatment were collected. Overall survival (OS) and progression-free survival was calculated with Kaplan-Meier method and log-rank test.
RESULTS
Between August 2011 and July 2019, 49 patients fulfilled the inclusion criteria, and all of them received neoadjuvant ChT. Fluorouracil+folinic acid, irinotecan and oxaliplatin was the most frequently used scheme (77%). The most prevalent grade 3 or 4 toxicities were neutropenia (26.5%), neurotoxicity (12.2%), diarrhoea (8.2%) and nausea (8.2%). 18 patients (36.7%) received ChRT thereafter. In total, 22 patients (44,9%) became potentially resectable and 19 of them had an R0 or R1 pancreatic resection. One was found to be unresectable at surgery and two refused surgery. A vascular resection was required in 7 (35%). No postoperative deaths were observed. Postoperative ChT was given to 12 (66.7%) of resected patients. Median OS of the whole cohort was 24,9 months (95% CI 14.1 to 35.7), with 30.6 months for resected and 13.1 months for non-resected patients, respectively (p<0.001).
CONCLUSION
A neoadjuvant approach in BRPC and LAUPC was well tolerated and allowed a curative resection in 38.8% of them with a potential improvement on OS.
简介
胰腺癌（PC）即使没有转移疾病，预后也很差。其中三分之一在诊断时为交界可切除（BRPC）或局部晚期不可切除（LAUPC）。目前尚无支持此类肿瘤最佳治疗方法的前瞻性数据。新辅助化疗（ChT）在这种情况下越来越多地使用。
方法
这是一项回顾性系列研究，连续纳入在学术中心多学科委员会（MDB）讨论后被诊断为 BRPC 或 LAUPC 的患者。所有患者均接受新辅助 ChT，随后在某些情况下接受放化疗（ChRT），并对达到足够降期的患者进行根治性手术。收集患者特征、新辅助治疗、毒性、根治性切除、术后并发症、病理报告和辅助治疗的描述性数据。使用 Kaplan-Meier 法和对数秩检验计算总生存期（OS）和无进展生存期。
结果
2011 年 8 月至 2019 年 7 月期间，共有 49 名患者符合纳入标准，所有患者均接受新辅助 ChT。氟尿嘧啶+亚叶酸、伊立替康和奥沙利铂是最常用的方案（77%）。最常见的 3 级或 4 级毒性为中性粒细胞减少症（26.5%）、神经毒性（12.2%）、腹泻（8.2%）和恶心（8.2%）。此后，18 名患者（36.7%）接受了 ChRT。共有 22 名患者（44.9%）可潜在切除，其中 19 名患者接受了 R0 或 R1 胰切除术。1 名患者在手术中发现无法切除，2 名患者拒绝手术。7 名患者（35%）需要血管切除。无术后死亡。12 名（66.7%）接受切除术的患者接受了术后 ChT。全队列的中位 OS 为 24.9 个月（95%CI 14.1 至 35.7），切除组为 30.6 个月，未切除组为 13.1 个月（p<0.001）。
结论
BRPC 和 LAUPC 的新辅助治疗方法耐受性良好，可使其中 38.8%的患者获得根治性切除，并可能改善 OS。
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