摘要
Approximately 25%of patients diagnosed with pancreatic cancer present with non-metastatic resectable or borderline resectable disease.Unfortunately,the cure rate for these“curable”patients is only in the range of 20%.Local-regional failure rates may exceed 50%after margin-negative,node-negative pancreatectomy,but up to 80%of resections are associated with regional lymph node or margin positivity.While systemic drug therapy and chemotherapy may prevent or delay the appearance of distant metastases,it is unlikely to have a significant impact on local-regional disease control.Preoperative radiotherapy would represent a rational intervention to improve local-regional control.The barrier to preoperative radiotherapy is the concern that it could potentially complicate what is already a long and complicated operation.When the radiotherapy is delivered with X-rays(photons),the entire cylinder of the abdomen is irradiated;therefore,an operating surgeon may be reluctant to accept the associated risk of increased toxicity.When preoperative radiotherapy is delivered with protons,however,significant bowel and gastric tissue-sparing is achieved and clinical outcomes indicate that proton therapy does not increase the risk of operative complications nor extend the length of the procedure.
Approximately 25% of patients diagnosed with pancreatic cancer present with non-metastatic resectable or borderline resectable disease. Unfortunately, the cure rate for these "curable" patients is only in the range of 20%. Local-regional failure rates may exceed 50% after margin-negative, node-negative pancreatectomy, but up to 80% of resections are associated with regional lymph node or margin positivity. While systemic drug therapy and chemotherapy may prevent or delay the appearance of distant metastases, it is unlikely to have a significant impact on local-regional disease control. Preoperative radiotherapy would represent a rational intervention to improve local-regional control. The barrier to preoperative radiotherapy is the concern that it could potentially complicate what is already a long and complicated operation. When the radiotherapy is delivered with X-rays(photons), the entire cylinder of the abdomen is irradiated;therefore, an operating surgeon may be reluctant to accept the associated risk of increased toxicity. When preoperative radiotherapy is delivered with protons,however, significant bowel and gastric tissue-sparing is achieved and clinical outcomes indicate that proton therapy does not increase the risk of operative complications nor extend the length of the procedure.
