Adjuvant 5-FU-based chemoradiotherapy for patients undergoing R-1/R-2 resections for pancreatic cancer
Adjuvant 5-FU-based chemoradiotherapy for patients undergoing R-1/R-2 resections for pancreatic cancer
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DOI：
10.1159/000089250
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发表时间：
2005-01-01
影响因子：
2.7
通讯作者：
van Eijck, CHJ
中科院分区：
文献类型：
--
作者：
Smeenk, HG;Incrocci, L;van Eijck, CHJ
背景：胰腺癌是全球癌症相关死亡的第五大原因。在仅接受手术治疗的患者中，肝转移发生率高达50%，腹膜复发发生率为25%，并且在所有接受切除术的患者中，局部复发发生率为50 - 80%。即使在宏观治愈性切除后，在20 - 51%（R-1）的切除标本的一个或多个边缘处也可通过显微镜观察到肿瘤细胞，这可能是局部复发率高的原因。研究目的：对54例接受胰腺癌非根治性切除术（R- 1和R- 2）的患者进行分析。33例患者接受了放化疗。为了评估治疗对生存和复发的影响，将该组与未接受放化疗的21例患者进行回顾性比较。研究方法：放疗采用上腹部外照射50戈伊，3周为1个疗程，每疗程前4天静脉注射5-FU 25 mg/kg/24 h。随访主要通过CT扫描进行，偶尔通过US进行，除1例患者外，所有患者均完成随访。结果：所有患者均完成治疗方案，无并发症。接受辅助治疗的患者组中有6例（18%）患者出现局部复发，而未接受辅助治疗的患者组中有16例（48%）患者出现局部复发（p = 0.001）。治疗组的中位生存时间为12.8个月，而未接受放化疗的组为13.7个月（p = 0.9）。3例（9%）患者在接受手术和辅助治疗后仍存活140、88和70个月。结论：辅助放化疗明显提供了一个显着更好的局部控制。然而，5-FU和放疗治疗并不能提高远处转移的生存率。这种疗法可能仅在少数患者中延长生存期。必须设计更有效的治疗方法来预防转移性疾病并提高生存率。
Background: Pancreatic cancer is the fifth leading cause of cancer-related death worldwide. Among patients treated with surgery alone, liver metastasis occurs in up to 50%, peritoneal recurrence in 25%, and local recurrence occurs in 50 - 80% of all patients who underwent resection. Even after a macroscopically curative resection, tumour cells might be observed by microscopy at one or more edges of the resected specimen in 20 - 51% (R-1) which might account for the high local recurrence. Aim of the Study: An analysis was performed in 54 patients who underwent an irradical resection (R- 1 and R- 2) for pancreatic cancer. 33 patients were treated with chemoradiotherapy. To evaluate the effect of therapy on survival and recurrence, this group was retrospectively compared to a group of 21 patients that did not receive chemoradiotherapy. Methods: Radiotherapy consisted of 50 Gy external upper abdomen radiation in two courses of 3 weeks, concomitant with intravenous 5-FU 25 mg/kg/24 h continuously on the first 4 days of each treatment course. Follow-up was performed mainly by CT scanning and occasionally by US and was completed for all but 1 patient. Results: The treatment protocol was completed in all patients without complications. Local recurrence was found in 6 (18%) patients in the group of patients who received adjuvant therapy versus 16 (48%) patients in the group that did not receive adjuvant therapy (p = 0.001). The median survival time for the treated group was 12.8 vs. 13.7 months in the group that did not receive chemoradiotherapy (p = 0.9). Three (9%) patients are still alive 140, 88 and 70 months after receiving surgery and adjuvant treatment. Conclusion: Adjuvant chemoradiotherapy clearly gives a significant better local control. However, treatment with 5-FU and radiotherapy does not improve survival due to distant metastases. This therapy probably prolongs survival in only a few patients. More effective treatment methods have to be designed to prevent metastatic disease and improve survival.