| 抄録 |
Background：The optimal surgical（S）approach to BRPC is unknown. We evaluated an approach to BPRC using extended course chemotherapy（CT）without routine neoadjuvant chemoradiation（CRT）. Clinical outcomes were evaluated on an “intent to treat” basis.
Methods：Patients（pts）were identified from a prospectively-maintained database started in 2008. Pts required 1）Dx BRPC with non-tail primary per radiographic staging using AHPBA/SSO guidelines 2）No prior therapy（Rx）3）Negative staging/exploratory laparoscopy prior to S 4）All cancer Rx at VMMC prior to S. Pts received gemcitabine/docetaxel（G/D）as initial CT. Pts with systemic progression/comorbid complication prior to 24 wks were not offered local Rx；medically fit pts with localized cancer at 24 wks judged likely to achieve R0 resection were offered S；all other pts were offered fluoropyrimidine-based chemoradiation（CRT）
Results：At the time of last full analysis 76 pts（median age 66）were identified in our database. 12（16%）are on initial CT and not fully evaluable. G/D as sole CT achieved 24 wk disease control in 46/64（72%）pts and ＞50% decline in baseline CA 19.9 in 39/55 pts（71%）. 53/64 fully evaluable pts（83%）completed 24 wks CT, 11/64 pts（17%）did not（4 systemic progression, 3 Rx- related, 4 intercurrent illness）. 50/53 pts attempted local Rx（40 S, 10 CRT, 2 unfit, 1 refused）. 30/40 pts（75%）had successful S（all R0）, 10/40 pts（25%）had inoperable disease（4 local-subsequently received CRT, 6 systemic）. 23/30 pts（77%）have received some form Rx post R0 resection. There were no postoperative deaths, 16% had a significant postoperative complication rate, and 30 day readmission rate was 10%. With median f/o of 20 mo, 23/44（52%）, 17/30（57%）, and 6/14（43%）receiving any local Rx, S, and CRT-only remain progression free. 13/30 S pts recurred, 3 local（10%）and 10 systemic（33%）. 1-yr, 2-yr, 3-yr, and median overall survivals（OS）for fully evaluable pts respectively are 82%, 50%, 36%, and 27 mo. Median OS for pts receiving CT-only（20 pts）, CT+CRT（14 pts）, and R0 pts are 12 mo, 17 mo, and ＞20 mo, respectively. 25/30 R0 pts remain alive（range 6-54 mo）.
Conclusions：1）Extended neoadjuvant CT without routine neoadjuvant CRT is a feasible approach to BRPC. 2）G/D has significant activity in BRPC. 3）Pretreatment surgical staging combined with the above Rx selects a subset of patients for curative surgery with acceptable morbidity and a significant probability of R0 resection. 4）OS for both resected and non-resected pt was superior to usual literature comparators. 5）These results will be updated at the time of the presentation. |
