Rich T A, Evans D B, Curley S A, Ajani J A
Department of Radiotherapy, University of Texas M. D. Anderson Cancer Center, Houston.
Ann Oncol. 1994;5 Suppl 3:75-80. doi: 10.1093/annonc/5.suppl_3.s75.
Due to the limited efficacy of surgery in pancreatico-biliary cancer, perioperative treatment modalities are of high clinical interest. Adjuvant chemoradiation with protracted infusion 5-FU for these tumors is an attractive direction for continued clinical research and may increase local control. Improved local control may influence survival as has been demonstrated by the results of adjuvant chemoradiation for operable rectal cancer. Newer combinations of chemotherapy and external beam radiotherapy (ExBRT) will need to be tested. The results of combined modality therapy indicate that increased normal tissue reactions occur and caution must be exercised during treatment especially in the areas of nutrition and fluid balance. New treatment strategies with electron beam IORT are also investigating higher doses of radiotherapy than those achieved with ExBRT alone in order to achieve better permanent tumor eradication. Data from our institution have demonstrated the safety of aggressive preoperative chemoradiation, surgical resection and IORT. Prophylactic hepatic and whole abdominal chemoradiation for occult liver disease needs further testing in clinical trials, since the liver is the single most frequent site of failure outside the primary site.
由于手术治疗在胰胆管癌中的疗效有限，围手术期治疗方式具有很高的临床研究价值。采用持续输注5-氟尿嘧啶对这些肿瘤进行辅助放化疗是持续临床研究的一个有吸引力的方向，可能会提高局部控制率。正如可手术直肠癌辅助放化疗的结果所示，改善局部控制可能会影响生存率。需要对更新的化疗与外照射放疗（ExBRT）联合方案进行测试。综合治疗的结果表明，正常组织反应会增加，治疗期间必须谨慎，尤其是在营养和液体平衡方面。采用电子束术中放疗（IORT）的新治疗策略也在研究比单纯ExBRT更高剂量的放疗，以实现更好的永久性肿瘤根除。我们机构的数据已证明积极的术前放化疗、手术切除和IORT的安全性。由于肝脏是原发部位以外最常见的单一复发部位，因此针对隐匿性肝病的预防性肝脏和全腹放化疗需要在临床试验中进一步测试。
