切换至 "中华医学电子期刊资源库"

中华肝脏外科手术学电子杂志 ›› 2022, Vol. 11 ›› Issue (05) : 524 -527. doi: 10.3877/cma.j.issn.2095-3232.2022.05.019

病例报告

局部进展期胰腺癌综合治疗一例
张继成1, 赵过超1, 张磊1, 施晨晔1, 吴莉莉2, 王明亮3, 张轶群4, 刘凌晓5, 纪元6, 周宇红7, 王单松1, 楼文晖1, 吴文川1,()   
  1. 1. 200032 上海,复旦大学附属中山医院普通外科
    2. 200032 上海,复旦大学附属中山医院放疗科
    3. 200032 上海,复旦大学附属中山医院影像医学科
    4. 200032 上海,复旦大学附属中山医院内镜中心
    5. 200032 上海,复旦大学附属中山医院介入科
    6. 200032 上海,复旦大学附属中山医院病理科
    7. 200032 上海,复旦大学附属中山医院肿瘤内科
  • 收稿日期:2022-05-16 出版日期:2022-10-10
  • 通信作者: 吴文川
  • 基金资助:
    国家自然科学基金(81773068); 上海市青年科技英才扬帆计划(21YF1407100)

Comprehensive managements for locally advanced pancreatic cancer: report of one case

Jicheng Zhang1, Guochao Zhao1, Lei Zhang1   

  • Received:2022-05-16 Published:2022-10-10
引用本文:

张继成, 赵过超, 张磊, 施晨晔, 吴莉莉, 王明亮, 张轶群, 刘凌晓, 纪元, 周宇红, 王单松, 楼文晖, 吴文川. 局部进展期胰腺癌综合治疗一例[J]. 中华肝脏外科手术学电子杂志, 2022, 11(05): 524-527.

Jicheng Zhang, Guochao Zhao, Lei Zhang. Comprehensive managements for locally advanced pancreatic cancer: report of one case[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2022, 11(05): 524-527.

胰腺癌恶性程度高,预后差,5年生存率低于10%,预计到2030年将成为全球第二大致死癌症[1,2,3]。80%~85%的患者在确诊时已发展为不可切除或转移阶段,丧失了手术机会,即使施行了根治性切除,术后5年生存率也仅仅10%~15%,绝大多数患者均要面临术后复发转移的现实困境[2]。因此,不管确诊时胰腺癌是否可切除,均需要综合治疗。不同个体在疾病进展过程中也要面临各种状态并需要进行治疗决策,治疗手段包括手术、放疗及化疗、靶向治疗和免疫疗法等近年也取得了一定进展[4,5,6]。本文通过回顾1例局部进展期胰腺癌综合治疗过程,分享笔者在治疗决策方面的体会和思考。

图1 一例局部进展期胰腺癌患者第一次手术前后影像学检查注:a、b分别为术前增强CT和MRI示胰头钩突肿块包绕肠系膜上动、静脉;c为术后2年半复查MRI示胰腺钩突肿瘤明显缩小,未发现肿瘤侵犯包绕肠系膜上动、静脉
图2 一例局部进展期胰腺癌患者第二次手术前后影像学检查注:a、b分别为术前增强CT示结肠肝曲、盆底均可见增强病灶;c为术后9个月增强MRI示胰头钩突肿块明显缩小,未见新发转移病灶
[1]
Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2021[J]. CA Cancer J Clin, 2021, 71(1):7-33.
[2]
Mizrahi JD, Surana R, Valle JW, et al. Pancreatic cancer[J]. Lancet, 2020, 395(10242):2008-2020.
[3]
Bear AS, Vonderheide RH, O'Hara MH. Challenges and opportunities for pancreatic cancer immunotherapy[J]. Cancer Cell, 2020, 38(6):788-802.
[4]
Nevala-Plagemann C, Hidalgo M, Garrido-Laguna I. From state-of-the-art treatments to novel therapies for advanced-stage pancreatic cancer[J]. Nat Rev Clin Oncol, 2020, 17(2):108-123.
[5]
Mahalingam D, Wilkinson GA, Eng KH, et al. Pembrolizumab in combination with the oncolytic virus pelareorep and chemotherapy in patients with advanced pancreatic adenocarcinoma: a phase Ⅰb study[J]. Clin Cancer Res, 2020, 26(1):71-81.
[6]
Reiss KA, Mick R, O'Hara MH, et al. Phase Ⅱ study of maintenance rucaparib in patients with platinum-sensitive advanced pancreatic cancer and a pathogenic germline or somatic variant in BRCA1, BRCA2, or PALB2[J]. J Clin Oncol, 2021, 39(22):2497-2505.
[7]
Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic adenocarcinoma, version 2.2021, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2021, 19(4):439-457.
[8]
Balaban EP, Mangu PB, Khorana AA, et al. Locally advanced, unresectable pancreatic cancer: American society of clinical oncology clinical practice guideline[J]. J Clin Oncol, 2016, 34(22):2654-2668.
[9]
Philip PA, Lacy J, Portales F, et al. Nab-paclitaxel plus gemcitabine in patients with locally advanced pancreatic cancer (LAPACT): a multicentre, open-label phase 2 study[J]. Lancet Gastroenterol Hepatol, 2020, 5(3):285-294.
[10]
Marthey L, Sa-Cunha A, Blanc JF, et al. FOLFIRINOX for locally advanced pancreatic adenocarcinoma: results of an AGEO multicenter prospective observational cohort[J]. Ann Surg Oncol, 2015, 22(1):295-301.
[11]
Seufferlein T, Hammel P, Delpero JR, et al. Optimizing the management of locally advanced pancreatic cancer with a focus on induction chemotherapy: expert opinion based on a review of current evidence[J]. Cancer Treat Rev, 2019(77):1-10.
[12]
Bednar F, Zenati MS, Steve J, et al. Analysis of predictors of resection and survival in locally advanced stage Ⅲ pancreatic cancer: does the nature of chemotherapy regimen influence outcomes?[J]. Ann Surg Oncol, 2017, 24(5):1406-1413.
[13]
Gemenetzis G, Groot VP, Blair AB, et al. Survival in locally advanced pancreatic cancer after neoadjuvant therapy and surgical resection[J]. Ann Surg, 2019, 270(2):340-347.
[14]
Stein SM, James ES, Deng Y, et al. Final analysis of a phase Ⅱ study of modified FOLFIRINOX in locally advanced and metastatic pancreatic cancer[J]. Br J Cancer, 2016, 114(7):737-743.
[15]
Fiore M, Ramella S, Valeri S, et al. Phase Ⅱ study of induction chemotherapy followed by chemoradiotherapy in patients with borderline resectable and unresectable locally advanced pancreatic cancer[J]. Sci Rep, 2017(7):45845.
[16]
Conroy T, Hammel P, Hebbar M, et al. FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer[J]. N Engl J Med, 2018, 379(25):2395-2406.
[17]
Teriaca MA, Loi M, Suker M, et al. A phase Ⅱ study of stereotactic radiotherapy after FOLFIRINOX for locally advanced pancreatic cancer (LAPC-1 trial): long-term outcome[J]. Radiother Oncol, 2021(155):232-236.
[18]
Buss EJ, Kachnic LA, Horowitz DP. Radiotherapy for locally advanced pancreatic ductal adenocarcinoma[J]. Semin Oncol, 2021, 48(1):106-110.
[19]
Murphy JE, Wo JY, Ryan DP, et al. Total neoadjuvant therapy with FOLFIRINOX in combination with losartan followed by chemoradiotherapy for locally advanced pancreatic cancer: a phase 2 clinical trial[J]. JAMA Oncol, 2019, 5(7):1020-1027.
[20]
Hammel P, Huguet F, Van Laethem JL, et al. Effect of chemoradiotherapy vs chemotherapy on survival in patients with locally advanced pancreatic cancer controlled after 4 months of gemcitabine with or without erlotinib: the LAP07 randomized clinical trial[J]. JAMA, 2016, 315(17):1844-1853.
[21]
Sohal DPS, Kennedy EB, Cinar P, et al. Metastatic pancreatic cancer: ASCO guideline update[J]. J Clin Oncol, 2020, 38(27):3217-3230.
[22]
Macchini M, Centonze F, Peretti U, et al. Treatment opportunities and future perspectives for pancreatic cancer patients with germline BRCA1-2 pathogenic variants[J]. Cancer Treat Rev, 2021(100):102262.
[23]
Sinn M, Sinn BV, Treue D, et al. TP53 mutations predict sensitivity to adjuvant gemcitabine in patients with pancreatic ductal adenocarcinoma: next-generation sequencing results from the CONKO-001 trial[J]. Clin Cancer Res, 2020, 26(14):3732-3739.
[1] 李辉, 吴奇, 张子琦, 张晗, 王仿, 许鹏. 日间全膝关节置换术早期疗效及标准化流程探索[J]. 中华关节外科杂志(电子版), 2023, 17(06): 889-892.
[2] 王玲燕, 邹磊, 洪亮, 宋三兵, 付润, 熊胜男, 宋晓春. 心脏外科术后患者并发低三碘甲状腺原氨酸综合征的影响因素分析[J]. 中华危重症医学杂志(电子版), 2023, 16(05): 399-402.
[3] 刘林峰, 王增涛, 王云鹏, 钟硕, 郝丽文, 仇申强, 陈超. 足底内侧皮瓣联合甲骨皮瓣在手指V度缺损再造中的临床应用[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 480-484.
[4] 张浩, 张万福, 韩飞, 佟琳, 王运帷, 李少辉, 陈阳, 曹鹏, 官浩. 游离组织瓣治疗无吻合血管或需困难吻合血管创面的临床进展[J]. 中华损伤与修复杂志(电子版), 2023, 18(05): 442-446.
[5] 晏晴艳, 雍晓梅, 罗洪, 杜敏. 成都地区老年转移性乳腺癌的预后及生存因素研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 636-638.
[6] 王晓燕, 肖佑, 肖戈, 王真权. 老年结直肠癌肺转移CT特征及高危因素研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(05): 506-509.
[7] 贾成朋, 王代宏, 陈华, 孙备. 可切除性胰腺癌预后术前预测模型的建立及应用[J]. 中华普外科手术学杂志(电子版), 2023, 17(05): 566-570.
[8] 康海, 谭武宾, 周松, 毛正, 米泽振, 李铁求. 膀胱癌根治术后阴茎转移一例报告[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(05): 523-525.
[9] 吴晨瑞, 廖锐, 贺强, 潘龙, 黄平, 曹洪祥, 赵益, 王永琛, 黄俊杰, 孙睿锐. MDT模式下肝动脉灌注化疗联合免疫靶向治疗肝细胞癌多处转移一例[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 713-716.
[10] 何传超, 肖治宇. 晚期肝癌综合治疗模式与策略[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 486-489.
[11] 李双喜, 胡宗凯, 赵静, 黄洁. 肝血管瘤治疗指征及治疗策略[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 504-510.
[12] 田驹, 孙伯洋, 杨荣华, 赵向前. 术中意外发现肝外胆管绒毛管状腺瘤的外科处理经验:附两例报道并文献复习[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 567-571.
[13] 李晓东, 魏云. 冠状切口额下入路治疗前颅窝巨大脑膜瘤[J]. 中华神经创伤外科电子杂志, 2023, 09(05): 318-319.
[14] 姜里蛟, 张峰, 周玉萍. 多学科诊疗模式救治老年急性非静脉曲张性上消化道大出血患者的临床观察[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 520-524.
[15] 程相阵. 腹茧症9例诊治分析并文献复习[J]. 中华临床医师杂志(电子版), 2023, 17(9): 968-971.
阅读次数
全文


摘要