Feasibilityofpancreatectomyfollowinghigh-doseprotontherapyforunresectablepancreaticcancer

摘要： AIMToreviewsurgicaloutcomesforpatientsundergoingpancreatectomyafterprotontherapywithconcomitantcapecitabineforinitiallyunresectablepancreaticadenocarcinoma.METHODSFromApril2010toSeptember2013,15patientswithinitiallyunresectablepancreaticcancerweretreatedwithprotontherapywithconcomitantcapecitabineat1000mgorallytwicedaily.Allpatientsreceived59.40Gy(RBE)tothegrossdiseaseand1patientreceived50.40Gy(RBE)tohigh-risknodaltargets.Therewerenotreatmentinterruptionsandnochemotherapydosereductions.Sixpatientsachievedaradiographicresponsesufficienttojustifysurgicalexploration,ofwhom1wasidentifiedashavingintraperitonealdisseminationatthetimeofsurgeryandtheplannedpancreatectomywasaborted.Fivepatientsunderwentresection.Proceduresincluded:Laparoscopicstandardpancreaticoduodenectomy(n=3),openpyloris-sparingpancreaticoduodenectomy(n=1),andopendistalpancreatectomywithirreversibleelectroporation(IRE)ofapancreaticheadmass(n=1).RESULTSThemedianpatientagewas60years(range,51-67).Themediandurationofsurgerywas419min(range,290-484),withamedianestimatedbloodlossof850cm~3(range,300-2000),medianICUstayof1d(range,0-2),andmedianhospitalstayof10d(range,5-14).Threepatientswerere-admittedtoahospitalwithin30dafterdischargeforwoundinfection(n=1),delayedgastricemptying(n=1),andischemicgastritis(n=1).TwopatientsunderwentR0resectionsanddemonstratedminimalresidualdiseaseinthefinalpathologyspecimen.Onepatient,afternegativepancreaticheadbiopsies,underwentIREfollowedbydistalpancreatectomywithnotumorseeninthespecimen.TwopatientsunderwentR2resections.Only1patientdemonstratedultimatelocalprogressionattheprimarysite.Mediansurvivalforthe5resectedpatientswas24mo(range,10-30).CONCLUSIONPancreaticresectionforpatientswithinitiallyunresectablecancersisfeasibleafterhigh-dose[59.4Gy(RBE)]protonradiotherapywithahighrateoflocalcontrol,acceptablesurgicalmorbidity,andamediansurvivalof24mo. ... （共6页）