胰腺癌辅助治疗的争议与共识

Controversies and consensus of the adjuvant therapy of pancreatic cancer

胰腺癌预后较差,即使接受了根治性切除术,术后复发和转移风险仍然很高。因此胰腺癌术后的辅助治疗至关重要,主要策略包括化疗或同期联合放化疗。然而就目前所公布的几项Ⅲ期临床研究而言,尚不足以确立一套业界公认的胰腺癌术后辅助治疗的规范流程。北美学者依据胃肠道肿瘤研究协作组(GI Tumor Study Group,GITSG)及美国肿瘤放射治疗协作组(Radiation Therapy Oncology Group,RTOG)的多项随机临床研究结果,推荐联合放化疗;而欧洲学者则根据ESPAC-1和CONKO-001研究结果,推荐采用单纯化疗。有关吉西他滨在辅助治疗方面是否优于氟尿嘧啶(5-FU)尚待ESPAC-3研究结果证实。本文回顾了该领域主要临床研究结果,提出就获完整切除的胰腺癌患者而言,术后接受6个月的标准剂量的吉西他滨辅助化疗(CONKO-001)或参照RTOG-9740研究的术后辅助放化疗策略,均是可取方案,但最佳策略仍需待大样本临床研究结果。

Pancreatic cancer is a highly malignant neoplasm with dismal prognosis. The risk of recurrence and metastasis remains high even for patients who have undergone radical dissection. Therefore, adjuvant therapy after ＂curative＂ resection is crucial. However, consensus on the optimal management of pancreatic cancer after surgery has not been reached. Both chemotherapy and concurrent chemoradiation therapy have been advocated. Yet, based upon the results of published phase Ⅲ trials, the consensus and standard strategy of adjuvant treatment after pancreatic cancer surgery is still under debate. According to the results of GITSG and RTOG trials, the mainstream in North American is adjuvant chemoradiation. However, based on the results of ESPAC-1 and CONKO-001 .studies, the oncologists in Europe usually recommend chemotherapy alone. Furthermore, the superiority of gemcitabine over 5-FU in the adjuvant setting is largely unclear. This article reviewed the main results of the clinical trials in the field of adjuvant treatment of pancreatic cancer. From the authors＇ view, both the standard dosage of gemcitabine （CONCO-001） and chemoradiation （RTOG-9704） after resection of pancreatic cancer could be considered as candidates for adjuvant strategy. However, the optimal therapy will have to be determined by trials with larger number of patients.