Breslin T M, Janjan N A, Lee J E, Pisters P W, Wolff R A, Abbruzzese J L, Evans D B
Departments of Surgical Oncology (TMB, JEL, PWTP, DBE), Radiation Oncology (NAJ), and Gastrointestinal Oncology and Digestive Diseases (RAW, JLA), The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
Front Biosci. 1998 Nov 1;3:E193-203. doi: 10.2741/a377.
Adjuvant 5-fluorouracil and concurrent radiation may improve survival following complete surgical resection in patients with pancreatic adenocarcinoma. However, the morbidity and prolonged recovery associated with pancreaticoduodenectomy frequently prevents the timely delivery of postoperative chemoradiation. Therefore, the University of Texas M.D. Anderson Cancer Center (MDACC) has investigated the use of neoadjuvant chemoradiation in potentially resectable pancreatic cancer. We have incorporated a standardized approach to pretreatment staging, operative technique and pathologic evaluation. Our initial experience suggests that preoperative chemoradiation is well tolerated and may reduce loco-regional recurrence. Patients treated with rapid-fractionation preoperative chemoradiation had a significantly shorter duration of treatment compared with patients who received postoperative chemoradiation or standard-fractionation preoperative chemoradiation. New and more potent radiation-sensitizing agents such as gemcitabine may further enhance local control. Novel therapies directed at specific molecular events involved in pancreatic tumorigenesis may be incorporated into preoperative and postoperative regimens to attempt to reduce systemic relapse.
辅助性5-氟尿嘧啶与同步放疗可能会提高胰腺腺癌患者在完整手术切除后的生存率。然而，胰十二指肠切除术相关的发病率和恢复时间延长常常妨碍术后放化疗的及时进行。因此，德克萨斯大学MD安德森癌症中心（MDACC）对新辅助放化疗在潜在可切除胰腺癌中的应用进行了研究。我们采用了标准化的预处理分期、手术技术和病理评估方法。我们的初步经验表明，术前放化疗耐受性良好，且可能降低局部区域复发率。与接受术后放化疗或标准分割术前放化疗的患者相比，接受快速分割术前放化疗的患者治疗时间显著缩短。新的、更有效的放疗增敏剂如吉西他滨可能会进一步增强局部控制效果。针对胰腺肿瘤发生过程中特定分子事件的新型疗法可纳入术前和术后治疗方案，以试图减少全身复发。
