Efficacy of preoperative radiochemotherapy in patients with locally advanced pancreatic carcinoma
Efficacy of preoperative radiochemotherapy in patients with locally advanced pancreatic carcinoma
复制标题
局部晚期胰腺癌术前放化疗的疗效观察
作者：
P. Lind;B. Isaksson;Markus Almström;A. Johnsson;N. Albiin;P. Byström;J. Permert
背景。不可切除的非转移性胰腺腺癌（PAC）患者的最佳护理是有争议的。我们连续治疗了17例术前放化疗（RCT）作为降低肿瘤分期的手段，并将结果与同期35例直接手术治疗主要可切除PAC的患者进行了比较。方法。患者活检证实，不可切除，非转移性PAC，≥50%的未闭肠系膜/门静脉周长≥2cm和/或<50%的中心动脉周长< 2cm。术前治疗包括两个疗程的Xelox（奥沙利铂130 mg/m2 d1；卡培他滨2 000 mg/m2 d1- 14 q 3 w），随后是3- d适形放疗（50.4 Gy； 1.8 Gy分数），Xelox （d1-5 q 1 w X 6）。结果。未发生与rct相关的3-4级CTC血液学副作用，6例非血液学副作用。16例患者完成了RCT，并在RCT后4周进行了CT重新扫描和手术重新评估。5例被诊断为新的肝脏转移。11例患者接受手术治疗，其中8例接受根治性r0切除术。后一组的中位总生存期为29个月，与我们的对照组患者进行直接治疗性手术，主要是可切除的PAC（中位生存期：16个月，RO-rate: 75%）相比有利。两组围手术期发病率相似，但rct组手术时间更长（576 vs 477 min），术中失血量更大（3288 vs 1460 ml） （p < 0.05）。两组的30天死亡率均为零。结论。在我们的治疗系列中，局部晚期PAC患者的术前RCT结果显示高治愈率和有希望的中位生存期。这种三位一体的方法值得在新的研究中进一步探索，目前我们部门正在进行这项研究。
Background. The optimal care for patients with unresectable, non-metastatic pancreatic adenocarcinoma (PAC) is debated. We treated 17 consecutive cases with preoperative radiochemotherapy (RCT) as a means for downstaging their tumours and compared outcome with 35 patients undergoing direct surgery for primarily resectable PAC during the same time period. Methods. The patients had biopsy proven, unresectable, non-metastatic PAC which engaged ≥50% of the circumference of a patent mesenteric/portal vein for a distance ≥2 cm and/or <50% of the circumference of a central artery for <2 cm. The preop therapy included two courses of Xelox (oxaliplatin 130 mg/m2 d1; capecitabine 2 000 mg/m2 d1–14 q 3 w) followed by 3-D conformal radiotherapy (50.4 Gy; 1.8 Gy fractions) with reduced Xelox (d1-5 q 1 w X 6). Results. No incident of RCT-related CTC Grade 3–4 haematologic and six cases of non-haematologic side-effects were diagnosed. Sixteen patients completed the RCT and were rescanned with CT and reevaluated for surgery 4 weeks post-RCT. Five cases were diagnosed with new metastases to the liver. Eleven patients were accepted for surgery whereof eight underwent a curative R0-resection. The median overall survival for the latter group was 29 months, which compared favourably with our control group of patients undergoing direct curative surgery for primarily resectable PAC (median OS: 16 months; RO-rate: 75%). Perioperative morbidity was similar in the two cohorts but the duration of surgery was longer (576 vs. 477 min) and the op blood loss was greater (3288 vs. 1460 ml) in the RCT-cohort (p < 0.05). The 30-day mortality was zero in both groups. Conclusion. Preoperative RCT in patients with locally advanced PAC resulted in a high rate of curative resections and promising median survival in our treatment series. This trimodality approach merits further exploration in new studies, which are currently underway at our Department.
影响因子：
9
作者：
Yeo, CJ;Cameron, JL;Abrams, RA
通讯作者：
Abrams, RA