Pancreaticoduodenectomy for pancreatic adenocarcinoma: Postoperative adjuvant chemoradiation improves survival - A prospective, single-institution experience
Pancreaticoduodenectomy for pancreatic adenocarcinoma: Postoperative adjuvant chemoradiation improves survival - A prospective, single-institution experience
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DOI：
10.1097/00000658-199705000-00018
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发表时间：
1997-05-01
影响因子：
9
通讯作者：
Cameron, JL
中科院分区：
文献类型：
--
作者：
Yeo, CJ;Abrams, RA;Cameron, JL
目的本研究旨在评估胰十二指肠切除术后胰腺腺癌患者的生存率，比较两种不同的术后辅助放化疗方案与无辅助治疗方案。背景资料：根据胃肠道肿瘤研究组有限的数据，对于头、颈或胰腺钩突腺癌，胰十二指肠切除术后推荐进行辅助放化疗。然而，许多患者仍然没有接受这样的治疗。方法1991年10月至1995年9月，我们对所有经手术、放射肿瘤学、内科肿瘤学和病理学证实的头部、颈部或胰腺钩突腺癌患者进行了多学科的回顾性研究，并对胰十二指肠切除术后的三种治疗方案进行了分析：1)标准治疗；胰腺床外束放射治疗（4000-4500 cGy），给予2个3天疗程的氟尿嘧啶（5-FU），随后每周给予5-FU （500 mg/m(2) /天），持续4个月；2)强化治疗：胰腺床外束放射治疗（5040-5760 cGy），预防性肝脏照射（2340-2700 cGy），同时给予5- fu （200mg /m(2) /天）加亚叶酸素（5mg /m(2) /天），每次输注5天，持续4个月；或3)无治疗：术后无放疗或化疗。结果174例患者行胰十二指肠切除术，住院死亡1例（0.6%）。99例选择标准治疗，21例选择强化治疗，53例拒绝治疗。三组患者在种族、性别、术中出血量、肿瘤分化、淋巴结状况、肿瘤直径和切除边缘状况等方面具有可比性。单因素分析表明肿瘤直径
Objective This study was designed to evaluate prospectively survival after pancreaticoduodenectomy for pancreatic adenocarcinoma, comparing two different postoperative adjuvant chemoradiation protocols to those of no adjuvant therapy.Summary Background Data Based on limited data from the Gastrointestinal Tumor Study Group, adjuvant chemoradiation therapy has been recommended after pancreaticoduodenectomy for adenocarcinoma of the head, neck, or uncinate process of the pancreas. However, many patients continue to receive no such therapy.Methods From October 1991 through September 1995, all patients with resected, pathologically confirmed adenocarcinoma of the head, neck, or uncinate process of the pancreas were reviewed by a multidisciplinary group (surgery, radiation oncology, medical oncology, and pathology) and were offered three options for postoperative treatment after pancreaticoduodenectomy: 1) standard therapy: external beam radiation therapy to the pancreatic bed (4000-4500 cGy) given with two 3-day fluorouracil (5-FU) courses and followed by weekly bolus 5-FU (500 mg/m(2) per day) for 4 months; 2) intensive therapy: external beam radiation therapy to the pancreatic bed (5040-5760 cGy) with prophylactic hepatic irradiation (2340-2700 cGy) given with and followed by infusional 5-FU (200 mg/m(2) per day) plus leucovorin (5 mg/m(2) per day) for 5 of 7 days for 4 months; or 3) no therapy: no postoperative radiation therapy or chemotherapy.Results Pancreaticoduodenectomy was performed in 174 patients, with 1 in-hospital death (0.6%). Ninety-nine patients elected standard therapy, 21 elected intensive therapy, and 53 patients declined therapy. The three groups were comparable with respect to race, gender, intraoperative blood loss, tumor differentiation, lymph node status, tumor diameter, and resection margin status. Univariate analyses indicated that tumor diameter