Feasibility and Efficacy of Combination Therapy With Preoperative Full-Dose Gemcitabine, Concurrent Three-Dimensional Conformal Radiation, Surgery, and Postoperative Liver Perfusion Chemotherapy for T3-Pancreatic Cancer
Feasibility and Efficacy of Combination Therapy With Preoperative Full-Dose Gemcitabine, Concurrent Three-Dimensional Conformal Radiation, Surgery, and Postoperative Liver Perfusion Chemotherapy for T3-Pancreatic Cancer
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DOI：
10.1097/sla.0b013e3181ad65cc
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发表时间：
2009-07-01
影响因子：
9
通讯作者：
Nishiyama, Kinji
中科院分区：
文献类型：
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作者：
Ohigashi, Hiroaki;Ishikawa, Osamu;Nishiyama, Kinji
目的：评价术前放化疗、手术及术后肝灌注化疗（LPC）联合治疗对T3（超出胰腺范围）胰腺癌患者的可行性和疗效。背景资料摘要：由于局部复发和肝转移的发生率较高，T3胰腺癌切除术后患者的远期预后极差。方法：2002年至2017年期间。 2007 年，38 名 T3 胰腺癌患者同意接受术前放化疗、手术和术后 LPC 联合治疗。在 3D 放射计划的帮助下，构建了包括原发性胰腺肿瘤和胰后组织的照射野，同时注意排除胃肠道的任何部分。放射总剂量为 50 Gy（2 Gy X 25 次/5 周），并与吉西他滨治疗联合施用（1000 mg/m(2)/周 x 9/3 个月）。通过计算机断层扫描进行术前重新分期和术中检查来确定是否需要进行胰腺切除术。对于受人尊敬的病例，将一根导管插入胃十二指肠动脉，另一根插入肠系膜上静脉。术后，通过这2种途径分别输注5-FU（125 mg/天×28天）。结果：所有38例患者均完成术前放化疗，其中3例需要减少吉西他滨剂量。七名患者（18%）没有接受手术切除，因为放化疗后发现远处转移或进展性局部肿瘤。其余 31 名患者 (82%) 接受了胰腺切除术加术后 LPC，无术后或院内死亡。胰腺切除术后5年生存率为53%，局部复发（91%）和肝转移（7%）的发生率都很低。术后组织病理学研究显示癌组织出现明显退行性改变，30 名患者 (96%) 的手术切缘 (R0) 为阴性，28 名患者 (90%) 的淋巴结受累为阴性。 结论：该试验的结果表明，术前全剂量吉西他滨、同步 3D 适形放疗、手术和术后 LPC 的组合治疗 T3 胰腺癌是可行的。使用本文描述的方法，我们能够有效降低局部和肝脏复发的发生率。因此，这种类型的联合疗法似乎有望改善 T3 期胰腺癌患者的长期预后。本研究已在大学医院医学信息网络临床试验登记号 UMIN000001804 注册。
Objective: To evaluate both the feasibility and efficacy of our combined therapy, which consisted of preoperativc chemoradiation, surgery, and postoperative liver perfusion chemotherapy (LPC) for patients with T3 (extended beyond the pancreatic confines) cancer of the pancreas.Summary Background Data: Because of the high incidence of local recurrence and liver metastasis, long-term outcomes for patients after resection of T3-pancreatic cancer arc extremely poor.Methods: During the period from 2002 to 2007, 38 patients with T3-pancreatic cancers consented to receive a combination of preoperative chemoradiation, surgery, and postoperative LPC. With the aid of 3D radiation planning, irradiation fields were constructed that included both the primary pancreatic tumor and retropancreatic tissues while taking care to exclude any section of the gastrointestinal tract. The total dose of radiation was 50 Gy (2 Gy X 25 firactions/5 weeks) and was administered in combination with gemcitabine treatments (1000 mg/m(2)/week x 9/3 months). Preoperative restaging via computerized tomography and intraoperative inspection were used to determine if pancreatectomy was indicated. For respected cases, One catheter was placed into the gastroduodenal artery and another one into the Superior mesenteric vein. Postoperatively, 5-FU (125 mg/day X 28 days) was infused via each of these 2 routes.Results: Preoperative chemoradiation was completed for all 38 patients, including 3 patients who required gemcitabine-dose reduction. Seven patients (18%) did not undergo Surgical resection because either distant metastases or progressive local tumors had been detected after chemoradiation. The remaining 31 patients (82%) underwent pancreatectomy plus postoperative LPC, without postoperative or in-hospital mortality. The 5-year survival rate after pancreatectomy was 53%, with low incidences of both local recurrence (91%) and liver metastasis (7%). Postoperative histopathologic study revealed a marked degenerative change in cancer tissue, showing negative surgical margins (R0) for 30 patients (96%) and negative nodal involvement for 28 patients (90%).Conclusion: Results of this trial suggest that a combination of preoperative full-dose gemcitabine, Concurrent 3D-conformal radiation, surgery, and postoperative LPC is feasible for the treatment of T3-pancreatic cancer. Using the method described in this article, we were able to effectively reduce the incidence of both local and liver recurrence. Therefore, this type of combination therapy seems promising for improving long-term outcomes for patients with T3-cancers of the pancreas. This study is registered with University hospital Medical information Network clinical trials Registry number, UMIN000001804.