局部胰腺癌精确放疗和放化综合治疗

王竞; 夏廷毅

doi:10.3969/j.issn.1001-5256.2014.03.010

局部胰腺癌精确放疗和放化综合治疗

DOI: 10.3969/j.issn.1001-5256.2014.03.010

王竞,
夏廷毅

1. 解放军总医院放射治疗科
2. 空军总医院肿瘤放疗科

详细信息

中图分类号: R735.9
计量
- 文章访问数: 3028
- HTML全文浏览量: 9
- PDF下载量: 635
- 被引次数: 0
出版历程
- 出版日期: 2014-03-20

Precise radiotherapy and chemoradiotherapy for localized pancreatic cancer

摘要

摘要:
胰腺癌是目前所有肿瘤中预后最差的肿瘤,早期局限性病变5年生存率不足20%。外科治疗水平已经处于平台期,尽管新的治疗药物不断出现,新的治疗技术不断应用,但是胰腺癌的生存并没有得到明显地改善。回顾了局部胰腺癌的治疗现状,阐明精确放疗在局部胰腺癌治疗中的疗效和作用,探讨放疗作为局部胰腺癌治疗选择的可能性,通过开展综合治疗的系列临床研究有可能改善局部胰腺癌患者的生存。
- 胰腺肿瘤 /
- 放射疗法 /
- 药物疗法,联合 /
- 综述
Abstract:
Pancreatic cancer ( PC) has the worst prognosis among all cancers, with a 5- year survival rate of less than 20% in patients with early local disease. The surgical treatment of PC has reached a plateau. Although novel drugs and treatment techniques have been increasingly applied, the survival of PC patients has not yet been improved significantly. The current status of treatment of localized PC is reviewed; the efficacy and role of precise radiotherapy are elucidated, and the potential of precise radiotherapy as the treatment option for localized PC is discussed. Clinical studies on multimodality therapy can be conducted to improve the survival of patients with localized PC.
- pancreatic neoplasms /
- radiotherapy /
- drug therapy, combination /
- review

HTML全文

参考文献(52)

[1]GAFFNEY DK.Radiation oncology:imaging and treatment[M].Altona, Manitoba, Canada:AMIRSYS, 2013:5-128.

[2]SPALDING D, WILLIAMSON RCN.Pancreatic cancer[J].Medicine (Baltimore) , 2011, 39:274-278.

[3]IEGEL R, NAISHADHAM D, JEMAL A.Cancer statistics[J].CA Cancer J Clin, 2013, 63:11-30.

[4]CHEN WQ, ZENG HM, ZHENG RS, et al.Cancer incidence and mortality in China[J].Chin J Caner Res, 2007, 24:1-8.

[5]BILIMORIA KY, BENTREM DJ, KO CY, et al.Validation of the6th edition AJCC Pancreatic Cancer Staging System:report from the National Cancer Database[J].Cancer, 2007, 110 (4) :738-744.

[6]TRAN KT, SMEENK HG, van EIJCK CH, et al.Pylorus preserving pancreaticoduodenectomy versus standard Whipple procedure:a prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors[J].Ann Surg, 2004, 240 (5) :738-745.

[7]SEILER CA, WAGNER M, BACHMANN T, et al.Randomized clinical trial of pylorus-preserving duodenopancreatectomy versus classical Whipple resection-long term results[J].Br J Surg, 2005, 92 (5) :547-556.

[8]LIN PW, SHAN YS, LIN YJ, et al.Pancreaticoduodenectomy for pancreatic head cancer:PPPD versus Whipple procedure[J].Hepatogastroenterology, 2005, 52 (65) :1601-1604.

[9]IQBAL N, LOVEGROVE RE, TILNEY HS, et al.A comparison of pancreaticoduodenectomy with pylorus preserving pancreaticoduodenectomy:a meta-analysis of 2822 patients[J].Eur J Surg Oncol, 2008, 34 (11) :1237-1245.

[10]YEO CJ, CAMERON JL, SOHN TA, et al.Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma:comparison of morbidity and mortality and short-term outcome[J].Ann Surg, 1999, 229 (5) :613-622.

[11]HAZARD L, TWARD JD, SZABO A, et al.Radiation therapy is associated with improved survival in patients with pancreatic adenocarcinoma:results of a study from the Surveillance, Epidemiology, and End Results (SEER) registry data[J].Cancer, 2007, 110 (10) :2191-2201.

[12]OETTLE H, POST S, NEUHAUS P, et al.Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer:a randomized controlled trial[J].JAMA, 2007, 297 (3) :267-277.

[13]POTOSKY AL, DAVIS WW, HOFFMAN RM, et al.Five-year outcomes after prostatectomy or radiotherapy for prostate cancer:the prostate cancer outcomes study[J].J Natl Cancer Inst, 2004, 96 (18) :1358-1367.

[14]PEETERS ST, HEEMSBERGEN WD, KOPER PC, et al.Dose-response in radiotherapy for localized prostate cancer:results of the Dutch multicenter randomized phase III trial comparing 68 Gy of radiotherapy with 78 Gy[J].J Clin Oncol, 2006, 24 (13) :1990-1996.

[15]KUBAN DA, TUCKER SL, DONG L, et al.Long-term results of the M.D.Anderson randomized dose-escalation trial for prostate cancer[J].Int J Radiat Oncol Biol Phys, 2008, 70 (1) :67-74.

[16]MA J, MAI HQ, HONG MH, et al.Results of a prospective randomized trial comparing neoadjuvant chemotherapy plus radiotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma[J].J Clin Oncol, 2001, 19 (5) :1350-1357.

[17]KAM MK, LEUNG SF, ZEE B, et al.Prospective randomized study of intensity-modulated radiotherapy on salivary gland function in early-stage nasopharyngeal carcinoma patients[J].J Clin Oncol, 2007, 25 (31) :4873-4879.

[18]GRILLS IS, MANGONA VS, WELSH R, et al.Outcomes after stereotactic lung radiotherapy or wedge resection for stage I non-small-cell lung cancer[J].J Clin Oncol, 2010, 28 (6) :928-935.

[19]LI Y, YAN Y, TIAN QH, et al.3-dimensional conformal radiation therapy plus arterial infusion chemotherapy for locally advanced pancreatic cancer[J].Chin J Radial Oncol, 2002, 11 (1) :15-17. (in Chinese) 李玉, 闫英, 田启和, 等.三维适形放射治疗加动脉化疗胰腺癌的疗效分析[J].中华放射肿瘤学杂志, 2002, 11 (1) :15-17.

[20]XIA TY, SUN QX, YU Y, et al.Analysis of clinical outcomes of body gamma knife therapy for 52 patients with advanced pancreatic cardnoma[J].Chin J Hepatobiliary Surg, 2006, 12 (2) :86-88. (in Chinese) 夏廷毅, 孙庆选, 于涌, 等.体部γ-刀治疗52例胰腺癌的疗效分析[J].中华肝胆外科杂志, 2006, 12 (2) :86-88.

[21]ZHOU GX, CHEN GX, CUI SX, et al.Treatment of pancreatic cancer with stereotactic radiotherapy in combination with external irradiation[J].Chin J Hepatobiliary Surg, 2001, 7 (7) :415-417. (in Chinese) 周桂霞, 陈国雄, 崔书祥, 等.体部立体定向适形放射治疗胰腺癌的临床初探[J].中华肝胆外科杂志, 2001, 7 (7) :415-417.

[22]YU JM, YU YH, YIN Y, et al.Stereotactic radio therapy for pancreatic head carcinoma:an analysis of 13 cases[J].Chin J Radiat Oncol, 2001, 10 (2) :125. (in Chinese) 于金明, 于甬华, 尹勇, 等.X射线立体定向放射治疗胰头癌13例分析[J].中华放射肿瘤学杂志, 2001, 10 (2) :125.

[23]CHANG DS, XIA TY, LI P, et al.Clinical outcome of whole bodyγ-knife for limited pancreatic carcinoma[J].Chin J Radial Oncol, 2009, 18 (6) :470-473. (in Chinese) 常冬姝, 夏廷毅, 李平, 等.全身γ刀治疗局限期胰腺癌临床结果分析[J].中华放射肿瘤学杂志, 2009, 18 (6) :470-473.

[24]WANG J, XIA TY, WANG YJ, et al.Long-term results of gamma ray-based stereotacitc body radiation therapy in treatment of medically unfit or inoperable non-metastatic pancreatic adenocarcinoma[J].Int J Radiat Oncol Biol Phys, 2012, 84:s815-816.

[25]LI G, YU YY, HAN C, et al.Efficacy analysis of three-dimensional conformal radiotherapy with increasing dose in late course in81 cases of pancreatic cancer patients[J].J China Med Univ, 2012, 41 (12) :1134-1143. (in Chinese) 李光, 于洋洋, 韩冲, 等.81例胰腺癌后程加量三维适形放疗的疗效分析[J].中国医科大学学报, 2012, 41 (12) :1134-1143.

[26]CHANG D, XIA T, LI P, et al.Promising clinical outcome of stereotactic body radiation therapy for limited pancreatic carcinoma[J].Int J Radiat Oncol Biol Phys, 2010, 78:s307.

[27]XIA T, SUN QX, LI HQ, et al.Clinical outcomes of whole body gamma knife therapy for 52 patients with advanced pancreatic carcinoma[J].Int J Radiat Oncol Biol Phys, 2006, 66:s298-s299.

[28]IKEDA M, IOKA T, ITO Y, et al.A multicenter phase II trial of S-1 with concurrent radiation therapy for locally advanced pancreatic cancer[J].Int J Radiat Oncol Biol Phys, 2013, 85 (1) :163-169.

[29]BLACKSTOCK AW, TEPPER JE, Niedwiecki D, et al.Cancer and leukemia group B (CALGB) 89805:phase II chemoradiation trial using gemcitabine in patients with locoregional adenocarcinoma of the pancreas[J].Int J Gastrointest Cancer, 2003, 34 (2-3) :107-116.

[30]HUGUET F, GIRARD N, GUERCHE CS, et al.Chemoradiotherapy in the management of locally advanced pancreatic carcinoma:a qualitative systematic review[J].J Clin Oncol, 2009, 27 (13) :2269-2277.

[31]KRISHNAN S, RANA V, JANJAN NA, et al.Induction chemotherapy selects patients with locally advanced, unresectable pancreatic cancer for optimal benefit from consolidative chemoradiation therapy[J].Cancer, 2007, 110 (1) :47-55.

[32]LOEHRER PJ Sr., FENG Y, CARDENES H, et al.Gemcitabine alone versus gemcitabine plus radiotherapy in patients with locally advanced pancreatic cancer:an Eastern Cooperative Oncology Group trial[J].J Clin Oncol, 2011, 29 (31) :4105-4112.

[33]MURPHY JD, ADUSUMILLI S, GRIFFITH KA, et al.Full-dose gemcitabine and concurrent radiotherapy for unresectable pancreatic cancer[J].Int J Radiat Oncol Biol Phys, 2007, 68 (3) :801-808.

[34]WILKOWSKI R, THOMA M, WEINGANDT H, et al.Chemoradiation for ductal pancreatic carcinoma:principles of combining chemotherapy with radiation, definition of target volume and radiation dose[J].Jop, 2005, 6 (3) :216-230.

[35]JINGU K, TANABE T, NEMOTO K, et al.Intraoperative radiotherapy for pancreatic cancer:30-year experience in a single institution in Japan[J].Int J Radiat Oncol Biol Phys, 2012, 83 (4) :e507-e511.

[36]CRANE CH, BEDDAR AS, EVANS DB.The role of intraoperative radiotherapy in pancreatic cancer[J].Surg Oncol Clin N Am, 2003, 12 (4) :965-977.

[37]MAXIMOUS DW, ABDEL-WANIS ME, EL-SAYED MI, et al.Preoperative gemcitabine based chemo-radiotherapy in locally advanced non metastatic pancreatic adenocarcinoma[J].Int Arch Med, 2009, 2 (1) :7.

[38]CHUONG MD, SPRINGETT GM, FREILICH JM, et al.Stereotactic body radiation therapy for locally advanced and borderline resectable pancreatic cancer is effective and well tolerated[J].Int J Radiat Oncol Biol Phys, 2013, 86 (3) :516-522.

[39]WHITE RR, HURWITZ HI, MORSE MA, et al.Neoadjuvant chemoradiation for localized adenocarcinoma of the pancreas[J].Ann Surg Oncol, 2001, 8 (10) :758-765.

[40]LE SCODAN R, MORNEX F, GIRARD N, et al.Preoperative chemoradiation in potentially resectable pancreatic adenocarcinoma:feasibility, treatment effect evaluation and prognostic factors, analysis of the SFRO-FFCD 9704 trial and literature review[J].Ann Oncol, 2009, 20 (8) :1387-1396.

[41]EVANS DB, VARADHACHARY GR, CRANE CH, et al.Preoperative gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head[J].J Clin Oncol, 2008, 26 (21) :3496-3502.

[42]VARADHACHARY GR, WOLFF RA, CRANE CH, et al.Preoperative gemcitabine and cisplatin followed by gemcitabine-based chemoradiation for resectable adenocarcinoma of the pancreatic head[J].J Clin Oncol, 2008, 26 (21) :3487-3495.

[43]STOCKEN DD, BUCHLER MW, DERVENIS C, et al.Meta-analysis of randomised adjuvant therapy trials for pancreatic cancer[J].Br J Cancer, 2005, 92 (8) :1372-1381.

[44]KLEEFF J, MICHALSKI CW, FRIESS H, et al.Surgical treatment of pancreatic cancer:the role of adjuvant and multimodal therapies[J].Eur J Surg Oncol, 2007, 33 (7) :817-823.

[45]NEOPTOLEMOS JP, DUNN JA, STOCKEN DD, et al.Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer:a randomised controlled trial[J].Lancet, 2001, 358 (9293) :1576-1585.

[46]Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer.Gastrointestinal Tumor Study Group[J].Cancer, 1987, 59 (12) :2006-2010.

[47]REGINE WF, WINTER KA, ABRAMS RA, et al.Fluorouracil vs gemcitabine chemotherapy before and after fluorouracil-based chemoradiation following resection of pancreatic adenocarcinoma:a randomized controlled trial[J].JAMA, 2008, 299 (9) :1019-1026.

[48]van LAETHEM JL, HAMMEL P, MORNEX F, et al.Adjuvant gemcitabine alone versus gemcitabine-based chemoradiotherapy after curative resection for pancreatic cancer:a randomized EORTC-40013-22012/FFCD-9203/G*ERCOR phase II study[J].J Clin Oncol, 2010, 28 (29) :4450-4456.

[49]HERMAN JM, SWARTZ MJ, HSU CC, et al.Analysis of fluorouracil-based adjuvant chemotherapy and radiation after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreas:results of a large, prospectively collected database at the Johns Hopkins Hospital[J].J Clin Oncol, 2008, 26 (21) :3503-1350.

[50]SMEENK HG, van EIJCK CH, HOP WC, et al.Long-term survival and metastatic pattern of pancreatic and periampullary cancer after adjuvant chemoradiation or observation:long-term results of EORTC trial 40891[J].Ann Surg, 2007, 246 (5) :734-740.

[51]REGINE WF, WINTER KA, ABRAMS R, et al.Fluorouracilbased chemoradiation with either gemcitabine or fluorouracil chemotherapy after resection of pancreatic adenocarcinoma:5-year analysis of the U.S.Intergroup/RTOG 9704 phase III trial[J].Ann Surg Oncol, 2011, 18 (5) :1319-1326.

[52]ZIMMERMANN FB, JEREMIC B, LERSCH C, et al.Dose escalation of concurrent hypofractionated radiotherapy and continuous infusion 5-FU-chemotherapy in advanced adenocarcinoma of the pancreas[J].Hepatogastroenterology, 2005, 52 (61) :246-250.

施引文献

资源附件(0)

访问统计