内容紹介
Summary
The treatment outcomes of unresectable pancreatic cancer(URPC)have improved due to the advent of gemcitabine with nab—paclitaxel(GnP)and FOLFIRINOX as first—line therapy. There have been increasing reports of URPC responding to chemotherapy or chemoradiation and that conversion surgery(CS)can help to achieve long—term survival. This study aims to assess the treatment outcomes of URPC in our department and consider CS adaptation. Thirty—six patients with URPC who were treated with GnP or FOLFIRINOX between 2015 and 2018 were included in this retrospective analysis. Thirty—five patients had GnP, while 1 patient had FOLFIRINOX. The median age of the patients was 68.0 years and included 17 males and 19 females. Twenty—eight of the tumors were located in the pancreas head and 8 in the body—tail. Twenty—one cases were locally advanced(UR—LA), and 15 cases had distant metastases(UR—M). CS was performed in 9 cases(25.0%). The 2—year survival rate for patients that underwent CS was 53.3%, and 34.1% for patients that did not undergo CS. The prognosis of patients who underwent CS tended to be better, but there was no significant difference(p=0.141). In the patients that underwent CS, there were cases of early recurrence in which the period of preoperative chemotherapy was short, and the tumor markers were not normalized. Therefore, it is thought that prolonging preoperative treatment could help to select more suitable patients for CS.
要旨
切除不能膵癌(URPC)の一次療法としてgemcitabine+nab—paclitaxel(GnP)療法やFOLFIRINOX療法の出現により,URPCの治療成績は向上している。また,化学療法または化学放射線療法により奏効し,外科切除(conversion surgery:CS)により長期生存するURPCの報告が増えてきている。当科におけるURPCの治療成績とCSの適応について検討した。対象は2015年1月～2018年10月までに一次治療としてGnP療法またはFOLFIRINOX療法を施行されたURPC 36例を対象とした。レジメンはGnP療法35例,FOLFIRINOX療法1例であった。年齢中央値68.0歳,男性17例/女性19例,腫瘍局在は頭部28例/体尾部8例であった。切除不能因子はUR—LA 21例/UR—M 15例であった。36例中9例(25.0%)にCSが施行された。CS施行例の2年生存率は53.3%で,CS非施行例の2年生存率は34.1%であり,CS施行例の予後がよい傾向にあったが有意差は認めなかった(p=0.141)。当科のCS症例では術前化学療法の期間が短い症例,腫瘍マーカーが正常化していない症例で早期再発例が存在した。治療効果を認めている場合は,術前治療期間を延長することでよりCSに適した症例を選別できると考えられた。
目次
The treatment outcomes of unresectable pancreatic cancer(URPC)have improved due to the advent of gemcitabine with nab—paclitaxel(GnP)and FOLFIRINOX as first—line therapy. There have been increasing reports of URPC responding to chemotherapy or chemoradiation and that conversion surgery(CS)can help to achieve long—term survival. This study aims to assess the treatment outcomes of URPC in our department and consider CS adaptation. Thirty—six patients with URPC who were treated with GnP or FOLFIRINOX between 2015 and 2018 were included in this retrospective analysis. Thirty—five patients had GnP, while 1 patient had FOLFIRINOX. The median age of the patients was 68.0 years and included 17 males and 19 females. Twenty—eight of the tumors were located in the pancreas head and 8 in the body—tail. Twenty—one cases were locally advanced(UR—LA), and 15 cases had distant metastases(UR—M). CS was performed in 9 cases(25.0%). The 2—year survival rate for patients that underwent CS was 53.3%, and 34.1% for patients that did not undergo CS. The prognosis of patients who underwent CS tended to be better, but there was no significant difference(p=0.141). In the patients that underwent CS, there were cases of early recurrence in which the period of preoperative chemotherapy was short, and the tumor markers were not normalized. Therefore, it is thought that prolonging preoperative treatment could help to select more suitable patients for CS.
要旨
切除不能膵癌(URPC)の一次療法としてgemcitabine+nab—paclitaxel(GnP)療法やFOLFIRINOX療法の出現により,URPCの治療成績は向上している。また,化学療法または化学放射線療法により奏効し,外科切除(conversion surgery:CS)により長期生存するURPCの報告が増えてきている。当科におけるURPCの治療成績とCSの適応について検討した。対象は2015年1月～2018年10月までに一次治療としてGnP療法またはFOLFIRINOX療法を施行されたURPC 36例を対象とした。レジメンはGnP療法35例,FOLFIRINOX療法1例であった。年齢中央値68.0歳,男性17例/女性19例,腫瘍局在は頭部28例/体尾部8例であった。切除不能因子はUR—LA 21例/UR—M 15例であった。36例中9例(25.0%)にCSが施行された。CS施行例の2年生存率は53.3%で,CS非施行例の2年生存率は34.1%であり,CS施行例の予後がよい傾向にあったが有意差は認めなかった(p=0.141)。当科のCS症例では術前化学療法の期間が短い症例,腫瘍マーカーが正常化していない症例で早期再発例が存在した。治療効果を認めている場合は,術前治療期間を延長することでよりCSに適した症例を選別できると考えられた。