5周和2周的新辅助放化疗方案治疗可切除和交界可切除胰腺癌的疗效和安全性比较

Efficacy and Safety of 5-week and 2-week Neoadjuvant Chemoradiotherapy in Treatment of Resectable and Borderline Resectable Pancreatic Cancer

目的比较5周和2周的新辅助放化疗方案治疗可切除和交界可切除胰腺癌的有效性和安全性。方法选择2018年2月—2020年8月来大连大学附属新华医院肿瘤内科接受新辅助放化疗的可切除或交界可切除胰腺导管腺癌患者56例,随机分为5周组30例和2周组26例。5周组采用5周治疗方案,2周组采用2周治疗方案,比较两组的R0切除率,新辅助治疗疗效、不良反应以及围手术期指标。结果5周组和2周组的R0切除率分别为93.33%和96.15%,差异无统计学意义(P>0.05)。两组间外周血白细胞、中性粒细胞、淋巴细胞计数、血清白蛋白水平、RECIST相关参数以及不良反应发生率比较,差异均无统计学意义(P>0.05)。然而,5周组的平均血清CA19-9水平和FDG-PET的平均最大标准化摄取值低于2周组,差异有统计学意义(P<0.01)。结论本研究明确了包括5周的替吉奥联合同步放疗的新辅助治疗和随后的根治性切除手术的这种综合治疗策略的临床有效性和可行性。

Objective To compare the efficacy and safety of 5-week and 2-week neoadjuvant chemoradiotherapy(NACRT)regimen for resectable pancreatic ductal adenocarcinoma(R-PDAC)and borderline resectable pancreatic ductal adenocarcinoma(BR-PDAC).Methods A total of 56 patients with R-PDAC or BR-PDAC,who received neoadjuvant chemoradiotherapy in the Department of Oncology of our hospital from February 2018 to August 2020,were assigned into 5-week group(n=30)and 2-week group(n=26)according to different neoadjuvant regimens.Patients in 5-week group received neoadjuvant chemoradiotherapy with S-1 and 50 Gy of radiation for 5 weeks,and patients in 2-week group underwent S-1 and 30 Gy of radiation for 2 weeks.R0 resection rate,neoadjuvant therapy efficacy,adverse events and perioperative indicators were compared between the two groups.Results The R0 resection rates of the 5-week group and the 2-week group were 93.33%and 96.15%,respectively,and there was no statistical difference between the groups(P>0.05).There were no significant differences in white blood cell count,neutrophil count,lymphocyte count,serum albumin level,RECIST related parameters and incidence of adverse events between two groups(P>0.05).Mean serum CA 19-9 level and maximum standardized uptake value(SUVmax)in FDG-PET in the 5-week group were significantly lower than those in the 2-week group(P<0.01).Conclusion This study identified the clinical efficacy and feasibility of a comprehensive treatment strategy including a 5-week neoadjuvant chemoradiotherapy regimen and subsequent radical resection.