BACKGROUND:The ideal neoadjuvant treatment protocol for patients with pancreatic cancer (PDAC) remains unclear. We evaluated the efficacy and safety of neoadjuvant hypofractionated chemoradiotherapy with S-1 for patients with resectable (R) and borderline resectable (BR) PDAC. METHODS:Eligibility criteria included patients with R and BR PDAC, performance status 0-1, and age 20-85 years. Hypofractionated external-beam radiotherapy (30 Gy in 10 fractions) with concurrent S-1 (60 mg/m2) was delivered 5 days/week for 2 weeks prior to pancreatectomy. RESULTS:Fifty-seven patients were enrolled in this study, including 33 R and 24 BR [19 BR tumors with portal vein contact (BR-PV) and 5 BR tumors with arterial contact (BR-A)]. The total rates of protocol treatment completion and resection were 91% (50/57) and 96% (55/57), respectively. Seven patients failed to complete S-1 due to cholangitis (n = 5) or neutropenia (n = 2). The most common grade 3 toxicities [Common Terminology Criteria for Adverse Events (CTCAE) version 4.0] were anorexia (7%), nausea (5%), neutropenia (4%), and leukopenia (4%). No patient experienced grade 4 toxicity. Pathologically negative margins (R0) were achieved in 54 of 55 patients (98%) who underwent pancreatectomy. Pathological response was classified as Evans grade I in 8 patients (15%), IIa in 31 patients (56%), IIb in 14 patients (25%), III in 1 patient (2%), and IV in 1 patient (2%), and operative morbidity (Clavien-Dindo grade IIIb or less) was observed in 4 patients (8%). The 1- and 2-year overall survival (OS) rates were 91 and 83% in R patients, respectively, and 77 and 58% in BR patients, respectively (p = 0.03). CONCLUSION:Neoadjuvant S-1 with concurrent hypofractionated radiotherapy is tolerable and appears promising for patients with R and BR PDAC.

译文

背景:胰腺癌(PDAC)患者理想的新辅助治疗方案尚不清楚。我们评估了可切除(R)和边缘可切除(BR)PDAC患者使用S-1的新辅助超分割放化疗的疗效和安全性。
方法:入选标准包括R和BR PDAC,表现状态0-1和20-85岁的患者。在胰腺切除术之前的2周中,每周5天,每次S-5(60 mg / m2)进行次分割放射束放射疗法(10份30 Gy)。
结果:57例患者入选本研究,包括33例R和24例BR [19例门静脉接触的BR肿瘤(BR-PV)和5例动脉接触的BR肿瘤(BR-A)]。方案治疗完成和切除的总比率分别为91%(50/57)和96%(55/57)。由于胆管炎(n = 5)或中性粒细胞减少症(n = 2),七名患者未能完成S-1。最常见的3级毒性[不良事件通用术语标准(CTCAE)4.0版]为厌食症(7%),恶心(5%),中性粒细胞减少症(4%)和白细胞减少症(4%)。没有患者经历过4级毒性。 55例接受胰腺切除术的患者中有54例(98%)达到了病理学阴性切缘(R0)。病理反应分为Evans I级:8例(15%),IIa≥31例(56%),IIb≥14例(25%),IIIb≥1例(2%),IV≥1例(2 %),并且在4例患者(8%)中观察到了手术发病率(Clavien-Dindo IIIb级或更低)。 R患者的1年和2年总生存率(OS)分别为91%和83%,BR患者分别为77%和58%(p = 0.03)。
结论:新辅助S-1联合并发次分割放疗是可以耐受的,对于R和BR PDAC的患者似乎很有希望。

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