Neoadjuvant strategies for pancreatic cancer
Neoadjuvant strategies for pancreatic cancer
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DOI：
10.3748/wjg.v20.i28.9374
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发表时间：
2014-07-28
影响因子：
4.3
通讯作者：
Frego, Mauro
中科院分区：
文献类型：
--
作者：
Polistina, Francesco;Di Natale, Giuseppe;Frego, Mauro
胰腺癌(PC)是西方国家第四大癌症死亡原因，长期生存的唯一机会是手术切除胰腺癌，手术切除率约为10%-20%。五年累计生存率不到5%，根治性切除患者的五年累计生存率上升到25%。约40%的患者接受了可切除性(BRPC)或不能局部切除(LAPC)的局部进展性PC。自从LAPC和BRPC被认为是PC的一种特殊形式以来，新辅助治疗(NT)日益成为一种有效的治疗选择。NT的目的是达到疾病的局部控制，但也被认为可以将大约40%的LAPC患者转变为R0可切除者，从而为有反应的患者提供显著的预后改善。一旦实现了R0切除，存活率与早期接受手术治疗的早期PC相当。因此，寻找合适的患者选择是至关重要的。新辅助策略是多重的，包括新辅助化疗(NCT)，以及NCT与放射治疗(NCRT)的关联，作为放射增敏药物如吉西他滨或卡培他滨的组合给予，或作为先期NCT和与放射增敏药物相关的NRT给予。后者似乎是最有希望的，因为它可以选择在最初治疗期间没有疾病进展的患者，并且似乎有更好的预后。NCRT的临床相关性可通过应用FOLFIRINOX等活性更高的方案来增强。(C)2014百仕登出版集团有限公司，版权所有。
Pancreatic cancer (PC) is the fourth cause of cancer death in Western countries, the only chance for long term survival is an RO surgical resection that is feasible in about 10%-20% of all cases. Five years cumulative survival is less than 5% and rises to 25% for radically resected patients. About 40% has locally advanced in PC either borderline resectable (BRPC) or unresectable locally advanced (LAPC). Since LAPC and BRPC have been recognized as a particular form of PC neoadjuvant therapy (NT) has increasingly became a valid treatment option. The aim of NT is to reach local control of disease but, also, it is recognized to convert about 40% of LAPC patients to R0 resectability, thus providing a significant improvement of prognosis for responding patients. Once R0 resection is achieved, survival is comparable to that of early stage PCs treated by upfront surgery. Thus it is crucial to look for a proper patient selection. Neoadjuvant strategies are multiples and include neoadjuvant chemotherapy (nCT), and the association of nCT with radiotherapy (nCRT) given as either a combination of a radio sensitizing drug as gemcitabine or capecitabine or and concomitant irradiation or as upfront nCT followed by nRT associated to a radio sensitizing drug. This latter seem to be most promising as it may select patients who do not go on disease progression during initial treatment and seem to have a better prognosis. The clinical relevance of nCRT may be enhanced by the application of higher active protocols as FOLFIRINOX. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.