Evaluation of the safety and pathological effects of neoadjuvant full-dose gemcitabine combination radiation therapy in patients with biliary tract cancer
Evaluation of the safety and pathological effects of neoadjuvant full-dose gemcitabine combination radiation therapy in patients with biliary tract cancer
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DOI：
10.1007/s00280-015-2908-3
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发表时间：
2015-12-01
影响因子：
3
通讯作者：
Sakon, Masato
中科院分区：
文献类型：
--
作者：
Kobayashi, Shogo;Tomokuni, Akira;Sakon, Masato
本研究旨在评价新辅助吉西他滨联合放疗治疗胆道癌的安全性，探讨放化疗的病理效应及其对生存的影响。放化疗包括三个周期的全剂量吉西他滨（1000 mg/m(2)，在第1、8和15天，每4周），在主要肿瘤和区域和主动脉旁淋巴结进行50-60 Gy （2 Gy/天）的放射治疗。本研究纳入25例患者。所有患者在治疗前均经病理诊断。吉西他滨的相对剂量强度为84%。平均辐照剂量为53.8 Gy。60%的患者行胰十二指肠切除术，32%的患者因胆管癌（n = 24）或胆囊癌（n = 1）行半肝切除术。在新辅助治疗期间，21例患者（84%）出现不良事件。常见的血液学不良事件是白细胞减少(44%)和血小板减少(32%)。11例（44%）患者需要更换塑料胆道支架。96%的患者实现了R0切除，16%的患者出现病理性淋巴结转移。32%的患者有中度或明显的组织学改变。第一次治疗后3年总生存率为74.6%，观察期为3.2年。新辅助治疗是可行的，并有望通过控制区域扩展来提高生存率。
This study aimed to evaluate the safety of neoadjuvant gemcitabine combination radiation therapy in the treatment of biliary tract cancer and to investigate the pathological effects of chemoradiation therapy and its impact on survival.Chemoradiation therapy entailed three cycles of full dose of gemcitabine (1000 mg/m(2) at days 1, 8, and 15, every 4 weeks) with 50-60 Gy radiation (2 Gy/day) at the main tumor and the regional and para-aortic lymph nodes. The present study included 25 patients.All of the patients were pathologically diagnosed before treatment. The relative dose intensity of gemcitabine was 84 %. The average dose of radiation was 53.8 Gy. Sixty percent of the patients underwent pancreatoduodenectomy, and 32 % underwent hemi-hepatectomy due to bile duct cancer (n = 24) or gall bladder cancer (n = 1). During neoadjuvant therapy, 21 patients (84 %) suffered from adverse events. The common hematological adverse events were leukopenia (44 %) and thrombocytopenia (32 %). It was necessary to exchange the plastic biliary stent in 11 patients (44 %). An R0 resection was achieved in 96 % of the patients, with pathological lymph node metastasis noted in 16 %. Moderate or marked histological changes were noted in 32 % of the patients. The 3-year overall survival rate after the first treatment was 74.6 %, with a 3.2-year observation period.Neoadjuvant therapy was feasible and is expected to improve survival by controlling regional extension.