Pancreatic cancer(PC)is the fourth cause of cancer death in Western countries,the only chance for long term survival is an R0 surgical resection that is feasible in about 10%-20%of all cases.Five years cumulative surv...Pancreatic cancer(PC)is the fourth cause of cancer death in Western countries,the only chance for long term survival is an R0 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 about40%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.展开更多
Pancreatic cancer remains one of the leading causes of cancer related death worldwide with an overall five-year survival of less than 5%. Potentially curative surgery, which alone can improve 5-year survival to 10%, i...Pancreatic cancer remains one of the leading causes of cancer related death worldwide with an overall five-year survival of less than 5%. Potentially curative surgery, which alone can improve 5-year survival to 10%, is an option for only 10%-20% of patients at presentation owing to local invasion of the tumour or metastatic disease. Adjuvant chemotherapy has been shown to improve 5-year survival to 20%-25% but conflicting evidence remains with regards to chemoradiation. In this article we review the current evidence available from published randomised trials and discuss ongoing phase III trials in relation to adjuvant therapy in pancreatic cancer.展开更多
文摘Pancreatic cancer(PC)is the fourth cause of cancer death in Western countries,the only chance for long term survival is an R0 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 about40%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.
文摘Pancreatic cancer remains one of the leading causes of cancer related death worldwide with an overall five-year survival of less than 5%. Potentially curative surgery, which alone can improve 5-year survival to 10%, is an option for only 10%-20% of patients at presentation owing to local invasion of the tumour or metastatic disease. Adjuvant chemotherapy has been shown to improve 5-year survival to 20%-25% but conflicting evidence remains with regards to chemoradiation. In this article we review the current evidence available from published randomised trials and discuss ongoing phase III trials in relation to adjuvant therapy in pancreatic cancer.
