Modern management of pancreatic carcinoma
Modern management of pancreatic carcinoma
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DOI：
10.1111/j.1444-0903.2004.00658.x
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发表时间：
2004-08-01
影响因子：
2.1
通讯作者：
Keogh, G
中科院分区：
文献类型：
--
作者：
Goldstein, D;Carroll, S;Keogh, G
胰腺癌仍然是一种可怕的疾病。对分子发病机制的新认识可能会影响治疗方式的选择，并为临床试验提供新的治疗策略。所有阶段患者的生存率都很差，临床试验是治疗的合适选择，应予以考虑。手术切除，在可能的情况下，仍然是主要的治疗方式，可以导致长期治愈。侵入性较小的技术，如腹腔镜，可以减少不必要的剖腹手术。辅助治疗的作用正在重新显现。不可切除和转移性疾病的患者是无法治愈的，最佳的姑息是目标。如果有症状，这些患者可以通过姑息性胆道或十二指肠梗阻旁路治疗获益。局部肿瘤浸润引起的疼痛可以通过放疗、化疗或不化疗、腹腔神经阻滞或局部神经外科手术得到缓解。化疗用吉西他滨有适度的客观反应率，但已显示改善症状。
Pancreatic cancer remains a fearsome disease. New insights into the molecular pathogenesis may influence choice of treatment modalities and provide avenues for novel therapeutic strategies for testing in the clinic. The survival rate of patients with all stages of disease is poor and clinical trials are appropriate alternatives for treatment and should be considered. Surgical resection, when possible, remains the primary treatment modality and can result in long-term cure. Less invasive techniques such as laparoscopy may reduce the rate of unnecessary laparotomies. The role of adjuvant therapy is re-emerging. Patients with unresectable and metastatic disease are incurable and optimal palliation is the goal. These patients may benefit from palliative bypass of biliary or duodenal obstruction if symptomatic. Pain associated with local tumour infiltration may be palliated with radiation, with or without chemotherapy, or with coeliac nerve blocks or local neurosurgical procedures. Chemotherapy with gemcitabine has modest objective response rates but has been shown to improve symptoms.