Yeung R S, Weese J L, Hoffman J P, Solin L J, Paul A R, Engstrom P F, Litwin S, Kowalyshyn M J, Eisenberg B L
Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111.
Cancer. 1993 Oct 1;72(7):2124-33. doi: 10.1002/1097-0142(19931001)72:7<2124::aid-cncr2820720711>3.0.co;2-c.
Low resectability rate and high locoregional recurrence are major factors contributing to the failure of surgical treatment for localized pancreatic adenocarcinoma. A Phase II study involving preoperative 5-fluorouracil (5-FU) and mitomycin C and radiation therapy was evaluated.
Thirty-one patients with biopsy-proven carcinoma (24, head of pancreas; 2, body; 5 duodenum) were treated with preoperative radiation therapy, 5040 cGy (180 cGy/fraction, 5 days/week), concurrent with 5-FU, 1000 mg/m2/day continuous infusion (days 2-5, 28-32) and mitomycin C 10 mg/m2 bolus (day 2). Ten patients had previous laparotomy or bypass surgery and were deemed unresectable; 21 had percutaneous, endoscopic retrograde choleangiopancreatic, or transhepatic stent biopsies.
Toxicity included neutropenic fever (2 patients), biliary sepsis (2 patients), and nausea and vomiting requiring total parenteral nutrition. One patient died of biliary sepsis before completion of chemoradiation and 11 patients showed evidence of metastatic disease (clinical or occult). Resectability rate was 38% (10/26) for pancreatic carcinoma and 80% (4/5) for duodenal carcinoma. Pathology of the resected specimens revealed extensive necrosis and hyalinization with clear margins in all cases. Lymph node metastases were found in one case of pancreatic carcinoma. The four resected duodenal carcinomas contained no residual tumor in the specimens. At a median follow-up of 29 months, the median survival time for those with pancreatic carcinoma was not yet reached in the resection group and was 8 months in the nonresection group. The corresponding actuarial 5-year survival rates were 58% and 0%, respectively.
Neoadjuvant chemoradiation therapy was given safely to patients with pancreatic and duodenal carcinoma. It facilitated complete resection in 38% of patients with pancreatic carcinoma and 80% of those with duodenal carcinoma. A significant downstaging of positive margins and regional lymph nodes occurs as a result of preoperative chemoradiation.
低切除率和高局部区域复发率是导致局限性胰腺腺癌手术治疗失败的主要因素。一项涉及术前5-氟尿嘧啶（5-FU）、丝裂霉素C和放射治疗的II期研究得到了评估。
31例经活检证实为癌的患者（24例位于胰头；2例位于胰体；5例位于十二指肠）接受了术前放射治疗，剂量为5040 cGy（180 cGy/分次，每周5天），同时给予5-FU，1000 mg/m²/天持续输注（第2 - 5天、28 - 32天）以及丝裂霉素C 10 mg/m²静脉推注（第2天）。10例患者曾接受过剖腹手术或旁路手术，被认为无法切除；21例患者进行了经皮、内镜逆行胰胆管造影或经肝支架活检。
毒性反应包括中性粒细胞减少性发热（2例患者）、胆源性败血症（2例患者）以及需要全胃肠外营养的恶心和呕吐。1例患者在放化疗完成前死于胆源性败血症，11例患者显示有转移疾病的证据（临床或隐匿性）。胰腺癌的切除率为38%（10/26），十二指肠癌的切除率为80%（4/5）。切除标本的病理显示所有病例均有广泛坏死和透明变性，切缘清晰。1例胰腺癌患者发现有淋巴结转移。4例切除的十二指肠癌标本中无残留肿瘤。中位随访29个月时，切除组胰腺癌患者的中位生存时间尚未达到，未切除组为8个月。相应的5年精算生存率分别为58%和0%。
新辅助放化疗对胰腺癌和十二指肠癌患者安全可行。它使38%的胰腺癌患者和80%的十二指肠癌患者能够实现完整切除。术前放化疗导致切缘阳性和区域淋巴结明显降期。
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