Adjuvant or neoadjuvant therapy for pancreatic carcinoma?
Adjuvant or neoadjuvant therapy for pancreatic carcinoma?
复制标题
胰腺癌的辅助治疗还是新辅助治疗？
作者：
J. Jeekel
胰腺癌的维普莱切除术是一种不适当的手术，应视为肿块切除术。辅助治疗应针对局部区域和肝脏复发。在美国，根据GITSG研究的结果，根治性维普莱切除术后的辅助治疗是标准程序，其中术后放疗和5-FU治疗使23例患者的生存率显著提高。然而，我们在鹿特丹的初步研究结果似乎并不能证实这些数据。在这项研究中，218例患者被随机分配到手术或40-戈伊和4周的5-FU治疗。另一种选择是新辅助治疗，具有理论优势。一些非随机研究似乎表明，放射治疗和5-FU治疗可能对胰腺癌的新辅助治疗形式有益。目前尚不清楚该朝哪个方向走。随机研究是必要的，以研究新辅助治疗与放疗和5-FU或区域灌注胰腺区的影响。
Whipple's resection for pancreatic cancer is an inadequate procedure and should be regarded as a lumpectomy. Adjuvant treatment should be directed towards local regional and liver recurrences. In the USA, adjuvant treatment after curative Whipple resection is standard procedure, based upon results of the GITSG study in which postoperative radiotherapy and 5-FU treatment resulted in significantly better survival in 23 patients. Preliminary results of our study in Rotterdam, however, do not seem to confirm these data. In this study, 218 patients were randomly assigned to surgery only or for 40-Gy radiotherapy and 4 weeks 5-FU treatment. Another option is neoadjuvant treatment which has theoretic advantages. A number of nonrandomized studies seem to indicate that radiotherapy and 5-FU treatment may have benefit in pancreatic cancer in a neoadjuvant treatment form. It is not clear which direction to take. Randomized studies are necessary to study the effect of neoadjuvant treatment with radiotherapy and 5-FU or with regional perfusion of the pancreatic area.