Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, Netherlands.
Cancer Center Amsterdam, Amsterdam, Netherlands.
Nat Rev Gastroenterol Hepatol. 2024 Feb;21(2):101-124. doi: 10.1038/s41575-023-00856-2. Epub 2023 Nov 30.
Surgical resection combined with systemic chemotherapy is the cornerstone of treatment for patients with localized pancreatic cancer. Upfront surgery is considered suboptimal in cases with extensive vascular involvement, which can be classified as either borderline resectable pancreatic cancer or locally advanced pancreatic cancer. In these patients, FOLFIRINOX or gemcitabine plus nab-paclitaxel chemotherapy is currently used as preoperative chemotherapy and is eventually combined with radiotherapy. Thus, more patients might reach 5-year overall survival. Patient selection for chemotherapy, radiotherapy and subsequent surgery is based on anatomical, biological and conditional parameters. Current guidelines and clinical practices vary considerably regarding preoperative chemotherapy and radiotherapy, response evaluation, and indications for surgery. In this Review, we provide an overview of the clinical evidence regarding disease staging, preoperative therapy, response evaluation and surgery in patients with borderline resectable pancreatic cancer or locally advanced pancreatic cancer. In addition, a clinical work-up is proposed based on the available evidence and guidelines. We identify knowledge gaps and outline a proposed research agenda.
手术切除联合全身化疗是局部胰腺癌患者治疗的基石。对于广泛血管受累的患者，术前手术被认为不理想，这些患者可被归类为边界可切除胰腺癌或局部进展期胰腺癌。在这些患者中，FOLFIRINOX 或吉西他滨加 nab-紫杉醇化疗目前被用作术前化疗，并最终与放疗联合使用。因此，更多的患者可能达到 5 年总生存率。化疗、放疗和随后手术的患者选择基于解剖、生物和条件参数。目前的指南和临床实践在术前化疗和放疗、反应评估以及手术适应证方面存在很大差异。在这篇综述中，我们概述了有关边界可切除胰腺癌或局部进展期胰腺癌患者的疾病分期、术前治疗、反应评估和手术的临床证据。此外，根据现有证据和指南提出了临床检查方案。我们确定了知识空白，并概述了拟议的研究议程。
