Miyazaki Kento, Hayashi Hiroki, Ishida Masaharu, Ohtsuka Hideo, Mizuma Masamichi, Nakagawa Kei, Morikawa Takanori, Motoi Fuyuhiko, Kamei Takashi, Shinoto Makoto, Yamada Shigeru, Takiyama Hirotoshi, Unno Michiaki
Dept. of Surgery, Tohoku University Graduate School of Medicine.
Gan To Kagaku Ryoho. 2020 Dec;47(13):2266-2268.
The neoadjuvant therapy against locally advanced pancreatic cancer(LAPC)have been developed by combining radiation with chemotherapy. We experienced a case of LAPC performed R0 resection and obtained high histopathological effect by carbon-ion radiotherapy with gemcitabine(GEM).
A 65-year-old male with epigastric and back pain was suspected as pancreas cancer by FDG-PET/CT scan, and was referred to our hospital. CT scan revealed a tumor in pancreatic body with poor contrast effect and with invasion to celiac artery, common hepatic artery and portal vein, and diagnosed as pancreatic adenocarcinoma by endoscopic ultrasound-fine needle aspiration(EUS-FNA). Therefore we diagnosed the tumor as pancreatic body cancer, cT4, cN1a, cM0, cStage Ⅲ, UR-LA. GEM plus nab-paclitaxel(GnP)were administered for 4 months followed by carbon-ion radiotherapy with GEM at other hospital. Distal pancreatectomy with en bloc celiac axis resection(DP-CAR)was performed 3 months after irradiation. High therapeutic effect was obtained histopathologically( Evans grade Ⅲ), and lesions outside the pancreas disappeared except for metastasis to one lymph node (ypT1c, ypN1a, ycM0, ypStage ⅡB), and R0 resection was performed.
Carbon-ion radiotherapy with chemotherapy for LAPC may improve curative resection rate.
通过将放疗与化疗相结合，已开发出针对局部晚期胰腺癌（LAPC）的新辅助治疗方法。我们诊治了一例LAPC患者，该患者接受了R0切除，并通过碳离子放疗联合吉西他滨（GEM）获得了较高的组织病理学疗效。
一名65岁男性，因上腹部和背部疼痛，经FDG-PET/CT扫描怀疑为胰腺癌，并转诊至我院。CT扫描显示胰体部有一肿瘤，强化效果差，侵犯腹腔干、肝总动脉和门静脉，经超声内镜引导下细针穿刺抽吸活检（EUS-FNA）诊断为胰腺腺癌。因此，我们将该肿瘤诊断为胰体癌，cT4，cN1a，cM0，cⅢ期，UR-LA。先行4个月的吉西他滨联合白蛋白结合型紫杉醇（GnP）治疗，随后在其他医院接受碳离子放疗联合GEM治疗。放疗3个月后行远端胰腺切除术联合腹腔干整块切除术（DP-CAR）。组织病理学检查获得了较高的治疗效果（埃文斯分级Ⅲ级），胰腺外病变消失，仅1个淋巴结转移（ypT1c，ypN1a，ycM0，ypⅡB期），实现了R0切除。
LAPC患者采用碳离子放疗联合化疗可能提高根治性切除率。
