Pathologic response with neoadjuvant chemotherapy and stereotactic body radiotherapy for borderline resectable and locally-advanced pancreatic cancer.
Pathologic response with neoadjuvant chemotherapy and stereotactic body radiotherapy for borderline resectable and locally-advanced pancreatic cancer.
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DOI：
10.1186/1748-717x-8-254
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发表时间：
2013-10-31
期刊：
影响因子：
--
通讯作者：
Burton SA
中科院分区：
文献类型：
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作者：
Rajagopalan MS;Heron DE;Wegner RE;Zeh HJ;Bahary N;Krasinskas AM;Lembersky B;Brand R;Moser AJ;Quinn AE;Burton SA
新辅助立体定向放射治疗（SBRT）在边缘可切除和局部晚期胰腺腺癌的治疗中具有潜在的适用性。在这个系列中，我们报告了在新辅助SBRT后接受手术的患者亚群的病理结果。边缘性可切除或局部晚期胰腺腺癌患者接受SBRT治疗并切除。化疗由内科肿瘤学家决定，大多数患者在SBRT之前进行化疗。12例患者符合纳入标准。大多数（92%）接受了新辅助化疗，吉西他滨/卡培他滨最常用（n = 7）。大多数患者接受36 Gy/3次SBRT分级治疗（n = 7），其余患者接受24 Gy/3次单一分级治疗（n = 5）。未发现SBRT引起的3级以上急性毒性反应。2例患者出现术后血管并发症，1例继发死亡。SBRT术后平均手术时间为3.3个月。92%的患者进行了R0切除（n = 11/12）。在25% （n = 3/12）的患者中，实现了完全的病理反应，另外16.7% （n = 2/12）的患者表现出<10%的活肿瘤细胞。Kaplan-Meier估计中位无进展生存期为27.4个月。1年、2年和3年的总生存率分别为92%、64%和51%。本研究报告了边缘可切除和局部晚期胰腺癌患者接受新辅助化疗和SBRT治疗的病理反应。根据我们的经验，92%的患者实现了R0切除，41.7%的患者对治疗表现出完全或广泛的病理反应。这种新方法的第二阶段研究结果即将公布。
Neoadjuvant stereotactic body radiotherapy (SBRT) has potential applicability in the management of borderline resectable and locally-advanced pancreatic adenocarcinoma. In this series, we report the pathologic outcomes in the subset of patients who underwent surgery after neoadjuvant SBRT. Patients with borderline resectable or locally-advanced pancreatic adenocarcinoma who were treated with SBRT followed by resection were included. Chemotherapy was to the discretion of the medical oncologist and preceded SBRT for most patients. Twelve patients met inclusion criteria. Most (92%) received neoadjuvant chemotherapy, and gemcitabine/capecitabine was most frequently utilized (n = 7). Most were treated with fractionated SBRT to 36 Gy/3 fractions (n = 7) and the remainder with single fraction to 24 Gy (n = 5). No grade 3+ acute toxicities attributable to SBRT were found. Two patients developed post-surgical vascular complications and one died secondary to this. The mean time to surgery after SBRT was 3.3 months. An R0 resection was performed in 92% of patients (n = 11/12). In 25% (n = 3/12) of patients, a complete pathologic response was achieved, and an additional 16.7% (n = 2/12) demonstrated <10% viable tumor cells. Kaplan-Meier estimated median progression free survival is 27.4 months. Overall survival is 92%, 64% and 51% at 1-, 2-, and 3-years. This study reports the pathologic response in patients treated with neoadjuvant chemotherapy and SBRT for borderline resectable and locally-advanced pancreatic cancer. In our experience, 92% achieved an R0 resection and 41.7% of patients demonstrated either complete or extensive pathologic response to treatment. The results of a phase II study of this novel approach will be forthcoming.