Pathological and clinical impact of neoadjuvant chemoradiotherapy using full-dose gemcitabine and concurrent radiation for resectable pancreatic cancer
Pathological and clinical impact of neoadjuvant chemoradiotherapy using full-dose gemcitabine and concurrent radiation for resectable pancreatic cancer
复制标题
DOI：
10.1007/s00534-012-0532-8
复制
发表时间：
2013-02-01
影响因子：
3
通讯作者：
Nakajima, Yoshiyuki
中科院分区：
文献类型：
--
作者：
Sho, Masayuki;Akahori, Takahiro;Nakajima, Yoshiyuki
可切除胰腺癌的术前治疗策略已受到全世界的关注。我们最近引入了新辅助放化疗（NACRT），以实现局部控制和可能的完全治愈。在这项研究中，我们回顾性评估了其对病理学和围手术期临床过程的影响，以及其安全性。61例术前接受全剂量吉西他滨（1000 mg/m2）并同时接受放疗（50或54戈伊）的患者接受了评估。71例未接受术前治疗的患者作为对照组。比较了围手术期结果、术后并发症、免疫营养状况和辅助化疗的效果。59例患者（97%）完成了NACRT。毒性是可接受的，方案是可行的门诊治疗。围手术期结局与对照组非常相似。NACRT组胰瘘发生率较低，住院时间较短。NACRT组的淋巴结转移率和分期率较低。此外，92%接受NACRT治疗的患者可以实现R 0切除。NACRT后营养状况下降，并在辅助化疗期间进一步恶化。NACRT组的术后化疗开始时间延迟。我们目前的新辅助放化疗方案是可行的，并大大改善了病理。然而，它对术后营养状况和辅助化疗的性能有一些不利影响。此外，应该注意的是，存在动脉并发症的可能性。
The therapeutic options available as preoperative strategies for resectable pancreatic cancer have received worldwide attention. We have recently introduced neoadjuvant chemoradiotherapy (NACRT) to achieve local control and possibly complete cure. In this study, we have retrospectively evaluated its impact on pathology and the perioperative clinical course in addition to its safety.Sixty-one patients who received full-dose gemcitabine (1000 mg/m(2)) preoperatively with concurrent radiation (50 or 54 Gy) were evaluated. Seventy-one patients who received no preoperative therapy served as controls. Perioperative outcomes, postoperative complications, immunonutritional status, and the performance of adjuvant chemotherapy were compared.Fifty-nine patients (97 %) completed NACRT. Toxicity was acceptable and the regimen was feasible as outpatient treatment. The perioperative outcomes were closely comparable to control. The rate of pancreatic fistula was lower and hospital stay was shorter in the NACRT group. The rate of lymph node metastasis and stage was lower in the NACRT group. Furthermore, R0 resection could be achieved in 92 % of patients treated with NACRT. Nutritional status decreased after NACRT and further deteriorated during adjuvant chemotherapy. The initiation of postoperative chemotherapy was delayed in the NACRT group.Our current protocol of neoadjuvant chemoradiotherapy is feasible and substantially improves the pathology. However, it has some detrimental effects on postoperative nutritional status and performance of adjuvant chemotherapy. Furthermore, it should be noted that there is a possibility of arterial complications.