| 抄録 |
Neoadjuvant therapy for Stage III pancreatic cancer may downstage borderline or locally advanced unresectable disease, and make resection or even cure possible. Adjuvant therapy after resection for pancreatic adenocarcinoma（“surgery first”）improves survival, but most patients still die from the disease. These poor results have stimulated other approaches to management, including neoadjuvant therapy even for those with early stage“resectable”disease who in most places around the world, would have had surgery first. There are a number of theoretical advantages to the neoadjuvant approach, including earlier treatment of occult micrometastases present in most, treatment of all patients with the disease（some patients never undergo adjuvant treatment after the operation）, better treatment tolerance, assessment of tumor response, and avoidance of surgery in some patients where metastases become apparent during treatment. A major theoretical disadvantage is the delay of surgery, usually at least several months, while treatment with an ineffective regimen is ongoing and the tumor progresses. This could deny some patients a chance for surgical resection and significant palliation or even cure. Recently a meta-analysis was published of 56 Phase I-II trials where patients with initially resectable tumors were either given chemotherapy and chemo-radiation or surgery first followed by adjuvant therapy. The authors concluded that resection frequencies（73.6%）and survival（median survival 23.3 months）after neoadjuvant therapy were similar to those of patients with apparently resectable tumors who had resection first followed by adjuvant therapy（78-96% and 20.1-23.6 months, respectively）. Thus, there was no apparent advantage to the neoadjuvant approach. Nevertheless, there is general agreement that a properly designed Phase III study is required to clarify the role of neoadjuvant treatment in patients with resectable pancreatic cancer. Presently, there are none. Various published studies will be presented and the difficulty of interpreting the existing data will be discussed. The principles of design of an appropriate prospective study will be outlined. |
