Preoperative Gemcitabine-based Chemoradiation Therapy for Resectable and Borderline Resectable Pancreatic Cancer.
Preoperative Gemcitabine-based Chemoradiation Therapy for Resectable and Borderline Resectable Pancreatic Cancer.
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用于可切除和临界可切除胰腺癌的术前基于吉西他滨的放化疗。
DOI：
10.1097/sla.0000000000000685
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发表时间：
2015
影响因子：
9
通讯作者：
G. Fusai
中科院分区：
文献类型：
--
作者：
R. Ravikumar;G. Fusai
致编辑：我们不仅祝贺作者的辉煌成果，还强调了新辅助治疗在胰腺癌患者治疗中的作用。术前放化疗联合或不联合诱导化疗的潜在益处早已被认识到，但由于存在肿瘤进展的潜在风险，在可切除病变的治疗中通常避免使用。相反，临界可切除组提供了一个很好的机会来研究新辅助治疗方式的价值，因为这些患者的理想治疗方法仍然未知，世界各地各不相同，而且最重要的是，这种情况的定义仍然存在争议。在这项研究中，作者应用了与 MD 安德森小组 2006 年提出的类似标准，但可切除性状态完全由动脉结构与肿瘤之间的关系来定义。特别是，只有那些动脉受累有限（血管圆周邻接不超过 180 度）的患者才被认为是边缘可切除的。最终，临界可切除组中 54% 的患者在新辅助放化疗后进行了切除，且肿瘤反应已得到记录（但不一定显着）。事实上，胰腺癌与强烈的基质反应和纤维化有关，这很少导致足够的降期以恢复动脉和肿瘤之间的正常组织平面。因此，令人惊讶的是，该组中只有 3 名患者需要重建肝总动脉。因此，由于壶腹周围肿瘤的采样和处理缺乏标准化，即使考虑到不同单位的组织病理学报告的差异，也很难将其与高达 98% 的 R0 率相协调。其次，该组 34% 的 5 年生存率是支持新辅助放化疗的一项了不起的成就。它进一步
To the Editor: We congratulate the authors not only for their brilliant results but also for highlighting the role of neoadjuvant treatment in the management of patients with pancreatic cancer. The potential benefit of preoperative chemoradiation with or without induction chemotherapy has been long recognized but is commonly avoided in the treatment of resectable lesions because of the potential risk of tumor progression. On the contrary, the borderline resectable group offers a great opportunity to investigate the value of neoadjuvant modalities as the ideal management of these patients is still unknown, differs across the world, and, most importantly, the definition of this condition remains controversial. In this study, the authors applied similar criteria to those suggested by the MD Anderson group in 2006, but the resectability status was defined exclusively by the relationship between the arterial structures and the tumor. In particular, only those patients with limited arterial involvement (no more than 180 degrees of circumferential abutment of the vessel) were considered borderline resectable. Ultimately, 54% of patients in the borderlineresectable group were resected after neoadjuvant chemoradiation and a documented, still not necessarily significant, tumor response. Indeed, pancreatic cancer is associated with intense stromal reaction and fibrosis, which rarely results in sufficient downstaging to restore a normal tissue plane between the artery and the tumor. It is therefore surprising that only 3 patients in this group required reconstruction of the common hepatic artery. As such, it is difficult to reconcile this with an astonishing R0 rate of 98%, even after considering the variation in histopathological reporting across different units, due to the lack of standardization of sampling and processing of periampullary tumors. Second, a 34% 5-year survival in this group is a remarkable achievement in support of neoadjuvant chemoradiation. It further