Kamthan A G, Morris J C, Dalton J, Mandeli J P, Chesser M R, Leben D, Cooperman A, Bruckner H W
Section of Hematology/Oncology, West Virginia University Health Sciences Center, Charleston, USA.
J Clin Oncol. 1997 Aug;15(8):2920-7. doi: 10.1200/JCO.1997.15.8.2920.
To study the outcome achieved with three-drug chemotherapy and split-course external-beam radiotherapy as a treatment for unresectable stage II and III pancreatic carcinoma.
Radiotherapy was given in three cycles of 2 Gy/d on days 1 to 5 and 8 to 12 (total dose, 54 Gy) concurrently with fluorouracil (FU) 1,000 mg/m2/d by continuous infusion for 4.5 days, streptozocin (STZ) 300 mg/m2 on days 1, 2, and 3 and cisplatin (P) 100 mg/m2 on day 3 of each every-28-day cycle. Subsequent treatment consisted of leucovorin (LV) 200 mg/m2 and FU 600 to 1,000 mg/m2 every 14 days.
The median survival time for the 35 patients was 15 months and 26% of patients were alive at 24 months. Fifteen patients (42.8%) had objective responses to therapy. Six (17%) had a complete response (CR). Three of nine patients with partial responses (PRs) achieved a radiographic CR within the next 3 months. Nine patients underwent attempts at surgical resection: five were resected (median survival time, 31 months; range, 12.8 to 44.7+), two had no residual disease found at complete resection, and three others also had a complete resection. Of four others who could not be resected, three underwent intraoperative radiotherapy and one had occult metastatic disease. Of primary tumors, 91% did not produce either back pain or local gastrointestinal complications for 2 years. The rates of severe side effects were stomatitis 15%, anemia 14%, granulocytopenia 6%, and thrombocytopenia 6%.
Palliation and survival compare favorably with other series, including many surgical series. The response findings encourage studies of both unresectable and (as neoadjuvant therapy) resectable tumors.
研究三联化疗联合分段外照射放疗治疗无法切除的Ⅱ期和Ⅲ期胰腺癌的疗效。
放疗分三个周期进行，每日剂量2 Gy，照射第1至5天及第8至12天（总剂量54 Gy），同时持续静脉输注氟尿嘧啶（FU）1000 mg/m²/d，共4.5天，链脲佐菌素（STZ）300 mg/m²于每个28天周期的第1、2、3天给药，顺铂（P）100 mg/m²于每个周期的第3天给药。后续治疗为每14天给予亚叶酸钙（LV）200 mg/m²及FU 600至1000 mg/m²。
35例患者的中位生存时间为15个月，26%的患者在24个月时仍存活。15例患者（42.8%）对治疗有客观反应。6例（17%）完全缓解（CR）。9例部分缓解（PR）患者中有3例在接下来3个月内达到影像学CR。9例患者尝试手术切除：5例成功切除（中位生存时间31个月；范围12.8至44.7+），2例在完全切除时未发现残留病灶，另外3例也实现了完全切除。另外4例无法切除的患者中，3例接受了术中放疗，1例有隐匿性转移疾病。原发性肿瘤中，91%在2年内未出现背痛或局部胃肠道并发症。严重副作用发生率为：口腔炎15%、贫血14%、粒细胞减少6%、血小板减少6%。
与其他系列研究相比，包括许多手术系列，本研究在缓解症状和生存方面表现良好。这些反应结果鼓励对无法切除的肿瘤以及（作为新辅助治疗）可切除的肿瘤进行研究。
