Pilot study of neoadjuvant chemotherapy with gemcitabine and oral S-1 for resectable pancreatic cancer
Pilot study of neoadjuvant chemotherapy with gemcitabine and oral S-1 for resectable pancreatic cancer
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DOI：
10.3892/etm.2012.482
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发表时间：
2012-05-01
影响因子：
2.7
通讯作者：
Kitamura, Seiko
中科院分区：
文献类型：
--
作者：
Tajima, Hidehiro;Ohta, Tetsuo;Kitamura, Seiko
单纯手术治疗胰腺癌的结果令人失望。我们回顾性评价了新辅助化疗（NAC）联合吉西他滨和口服S-1治疗可能可切除的胰腺癌患者的疗效和耐受性。共有34例胰腺导管腺癌患者，术前经放射学诊断为可能可切除的肿瘤，在金泽大学医院接受了胰腺切除术和淋巴结切除术。NAC组13例，给予NAC治疗。其余21例患者手术治疗，术前不化疗（对照组）。比较两组的手术效果，并随访至少24个月。NAC组和对照组之间的临床病理背景数据（肿瘤位置、年龄、性别、淋巴结转移、肿瘤分期和肿瘤大小）无统计学显著差异。术前化疗后，没有患者被判定为不能接受剖腹手术，即，既没有观察到远处转移也没有观察到肿瘤进展。放射学上，所有13名NAC组患者病情稳定，而组织病理学上，所有肿瘤标本显示肿瘤细胞的证据。Evans分级：IIa级11例，IIb级2例。对11例患者进行了毒性评价。III级副作用被视为血液学毒性，即，白细胞减少（7.7%）和血小板减少（15.4%）。此外，NAC组和对照组的围手术期并发症发生率无显著差异。NAC组胰头癌患者的1年和3年总生存率分别为88.9%和55.6%，上级优于对照组的88.9%和29.6%（p=0.055）。因此，NAC与吉西他滨和5-1耐受性良好，对胰头癌可能有效。一项NAC联合吉西他滨和S-1治疗可切除胰腺癌患者的I期研究正在进行中。
Results of surgery alone for pancreatic cancer are disappointing. We retrospectively evaluated the efficacy and tolerability of neoadjuvant chemotherapy (NAC) with gemcitabine and oral S-1 in patients with potentially resectable pancreatic cancer. A total of 34 patients with pancreatic ductal adenocarcinoma, radiollogically diagnosed preoperatively as having potentially resectable tumors, underwent pancreatic resection with lymphadenectomy at Kanazawa University Hospital. NAC was administered to 13 patients (NAC group). The remaining 21 patients were surgically treated without preoperative chemotherapy (control group). Surgical results were compared between these two groups, with follow-up for at least 24 months. No statistically significant differences were found in the clinicopathological background data (tumor location, age, gender, lymph node metastases, tumor stage and tumor size) between the NAC and control groups. Following preoperative chemotherapy, no patients were judged to be unable to undergo laparotomy, i.e., neither distant metastasis nor tumor progression was observed. Radiologically, all 13 NAC group patients had stable disease, whereas, histopathologically, all tumor specimens showed evidence of tumor cells. The treatment effect was judged by Evans grading to be grade IIa in 11 patients and grade IIb in 2 patients. Toxicity was evaluated in 11 patients. Grade III side effects were regarded as hematological toxicity, i.e., leucopenia (7.7%) and thrombocytopenia (15.4%). Moreover, the incidence of perioperative complications did not differ significantly between the NAC and control groups. The one- and three-year overall survival rates of the NAC group with pancreatic head cancer were 88.9 and 55.6%, respectively, superior to 88.9 and 29.6% in the control group (p=0.055). Therefore, NAC with gemcitabine and 5-1 is well tolerated and potentially effective against pancreatic head cancer. A phase 1 study of NAC with gemcitabine and S-1 is under way in patients with resectable pancreatic cancer.