Evans O B, Abbruzzese J L, Cleary K R, Lee J E, Buchholz D J, Rich T A
Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
J R Coll Surg Edinb. 1995 Oct;40(5):319-23.
The multimodality treatment of adenocarcinoma of the pancreatic head has been shown to improve survival compared with surgery alone. The delivery of chemotherapy and radiation therapy (chemoradiation) before rather than after pancreaticoduodenectomy ensures that all patients who undergo surgery receive the other components of multimodality therapy. In an effort to reduce overall treatment time and cost, the use of rapid-fractionation preoperative chemoradiation was explored. Radiation therapy was delivered with 18-MeV photons to a total dose of 30 Gy given in 10 fractions over 2 weeks. 5-Fluorouracil was given concurrently by continuous infusion at a dose of 300 mg m-2 day-1. Four weeks after the completion of chemoradiation, patients underwent pancreaticoduodenectomy and electron-beam intraoperative radiation therapy (10 Gy). All patients completed the treatment programme without delay. The rapid-fractionation programme was delivered at nearly half the cost of standard chemoradiation and histologic evidence of tumour cell injury was present in all resected specimens. There were no perioperative anastomotic complications, and median hospital stay was 20 days. Rapid-fractionation chemoradiation warrants further study in the neoadjuvant setting.
与单纯手术相比，胰头腺癌的多模式治疗已被证明可提高生存率。在胰十二指肠切除术之前而非之后进行化疗和放疗（放化疗），可确保所有接受手术的患者都能接受多模式治疗的其他组成部分。为了减少总体治疗时间和成本，人们探索了使用快速分割术前放化疗的方法。使用18兆电子伏光子进行放射治疗，总剂量为30 Gy，在2周内分10次给予。5-氟尿嘧啶通过持续输注同时给予，剂量为300 mg m-2 天-1。放化疗完成4周后，患者接受胰十二指肠切除术和电子束术中放射治疗（10 Gy）。所有患者均按时完成了治疗方案。快速分割方案的成本几乎是标准放化疗的一半，并且所有切除标本中均有肿瘤细胞损伤的组织学证据。没有围手术期吻合口并发症，中位住院时间为20天。快速分割放化疗在新辅助治疗方面值得进一步研究。
