André T, Balosso J, Louvet C, Houry S, Vaillant J C, Touboul E, Lotz J P, de Gramont A, Izrael V
Service d'Oncologie médicale, Hôpital Tenon, Paris.
Presse Med. 1998 Mar 21;27(11):539-45.
Surgery whether curative or palliative, is the major modality of treatment. A complete resection is possible in about 20% of patients with a median survival of 12 to 16 months and a 20% five year survival. After complete resection 70 to 80% of patients develop a local recurrence. Biliary and gastro-intestinal bypasses as well as antalgic techniques are useful palliative procedures.
Chemoradiotherapy is used either as adjuvant or neoadjuvant treatment. External beam irradiation techniques are used to deliver 45 to 50 Gy to the pancreas in five to six weeks. Concomitant fluorouracil is administered in bolus injections or better in continuous infusion,, either alone or in association with cisplatinum. Chemoradiotherapy reduces the local relapse rate and slightly, though significantly, increases the median survival. Therefore, after chemoradiotherapy, metastatic spread becomes the major cause of death.
For locally advanced diseases, chemoradiotherapy has a true palliative effect with acceptable toxicity. Metastatic disease remains a challenge. Fluorouracil based chemotherapy with or without cisplatinum occasionally obtains effective palliation. Among new agents, only gemcitabine has proven clinical activity associated with low toxicity and is practical to use.
Presently, patients with resectable pancreatic carcinoma should be included in a prospective trial to receive combined modality treatment with adjuvant or neo-adjuvant chemoradiotherapy. The choice of treatment for patients with locally advanced or metastatic disease, should be based on the possibility of assuring a satisfactory quality of life. Present research should progress through controlled clinical trials to study original systemic treatment and combined modalities able to produce a lasting local control.
手术无论是根治性还是姑息性的，都是主要的治疗方式。约20%的患者有可能进行完整切除，其平均生存期为12至16个月，5年生存率为20%。完整切除后，70%至80%的患者会出现局部复发。胆管和胃肠道搭桥术以及止痛技术是有用的姑息性手术。
放化疗用作辅助或新辅助治疗。外照射技术用于在五至六周内对胰腺给予45至50 Gy的剂量。同时给予氟尿嘧啶，采用大剂量注射，或更好的是持续输注，可单独使用或与顺铂联合使用。放化疗可降低局部复发率，并轻微但显著地提高平均生存期。因此，放化疗后，转移扩散成为主要的死亡原因。
对于局部晚期疾病，放化疗具有真正的姑息作用，且毒性可接受。转移性疾病仍然是一个挑战。含或不含顺铂的基于氟尿嘧啶的化疗偶尔可获得有效的姑息效果。在新的药物中，只有吉西他滨已被证明具有临床活性，且毒性低，使用方便。
目前，可切除胰腺癌患者应纳入前瞻性试验，接受辅助或新辅助放化疗的联合治疗。对于局部晚期或转移性疾病患者的治疗选择，应基于确保令人满意的生活质量的可能性。当前的研究应通过对照临床试验来推进，以研究能够产生持久局部控制的原始全身治疗和联合治疗方式。
