内容紹介
Summary
Several multicenter trials are in progressive regarding neoadjuvant treatment for pancreatic cancer to improve survival for pancreatic cancer. However, neoadjuvant treatment for pancreatic cancer is not yet standardized, although neoadjuvant treatment has gained increasing importance in recent years. No clear recommendation for any treatment standard is yet established. The potential advantages of neoadjuvant treatment are to deliver high dose intensity without the potential delays caused by surgical complications and delayed recovery or increase R0 rate. Additionally, neoadjuvant treatment may identify those patients with particularly aggressive disease, who would likely not benefit from resection. The disadvantages of neoadjuvant treatment are possibility of increasing postoperative outcomes or losing the chances for operations due to adverse effects of neoadjuvant treatment. Additionally, neoadjuvant treatment may cause metastasizing or becoming unresectable due to tumor progression during neoadjuvant treatment. Furthermore studies regarding neoadjuvant treatment for pancreatic cancer should be required to clarify as follows; patients selection to receive neoadjuvant treatment, selection of chemotherapy or radiochemotherapy as neoadjuvant treatment, appropriate regimens for neoadjuvant treatment, and appropriate periods for neoadjuvant treatment.
要旨
最近,膵癌の術前治療において多くの多施設共同研究が行われている。しかし膵癌に対する術前治療の治療成績の改善が期待されているが,課題も多い。術前治療の利点は,後補助療法に比較して術後合併症の影響を受けずにperformance statusのよい時期にfull doseの治療を行えることによる腫瘍の縮小,R0率および切除率の向上や潜在的転移を有する症例における転移細胞の抑制などがある。一方,術前治療の無効による症状進行および有害事象により手術機会を逸する問題もある。① 膵癌に術前治療が必要かという問題(適応症例の選定),② 化学療法あるいは放射線化学療法の選択,③ 至適レジメン,④ 術前治療期間などの問題を解決しなければならない。
目次
Several multicenter trials are in progressive regarding neoadjuvant treatment for pancreatic cancer to improve survival for pancreatic cancer. However, neoadjuvant treatment for pancreatic cancer is not yet standardized, although neoadjuvant treatment has gained increasing importance in recent years. No clear recommendation for any treatment standard is yet established. The potential advantages of neoadjuvant treatment are to deliver high dose intensity without the potential delays caused by surgical complications and delayed recovery or increase R0 rate. Additionally, neoadjuvant treatment may identify those patients with particularly aggressive disease, who would likely not benefit from resection. The disadvantages of neoadjuvant treatment are possibility of increasing postoperative outcomes or losing the chances for operations due to adverse effects of neoadjuvant treatment. Additionally, neoadjuvant treatment may cause metastasizing or becoming unresectable due to tumor progression during neoadjuvant treatment. Furthermore studies regarding neoadjuvant treatment for pancreatic cancer should be required to clarify as follows; patients selection to receive neoadjuvant treatment, selection of chemotherapy or radiochemotherapy as neoadjuvant treatment, appropriate regimens for neoadjuvant treatment, and appropriate periods for neoadjuvant treatment.
要旨
最近,膵癌の術前治療において多くの多施設共同研究が行われている。しかし膵癌に対する術前治療の治療成績の改善が期待されているが,課題も多い。術前治療の利点は,後補助療法に比較して術後合併症の影響を受けずにperformance statusのよい時期にfull doseの治療を行えることによる腫瘍の縮小,R0率および切除率の向上や潜在的転移を有する症例における転移細胞の抑制などがある。一方,術前治療の無効による症状進行および有害事象により手術機会を逸する問題もある。① 膵癌に術前治療が必要かという問題(適応症例の選定),② 化学療法あるいは放射線化学療法の選択,③ 至適レジメン,④ 術前治療期間などの問題を解決しなければならない。