臨床外科66巻11号

2011年10月発行

特集 外科医のための最新癌薬物療法 Ⅰ章 臓器別薬物療法

9．膵癌―①術前療法

著者： 相浦浩一¹ 北郷実² 真杉洋平³ 坂元亨宇³ 北川雄光²

所属機関： ¹川崎市立川崎病院外科 ²慶應義塾大学医学部外科 ³慶應義塾大学医学部病理学教室

ページ範囲：P.209 - P.217

術前療法の適応とレジメン選択

術前療法の意義と適応

　唯一根治が期待できる手術療法でも手術単独では治療成績に限界があり，集学的治療法が必須である．その一環として術前療法が存在するが，膵癌診療ガイドライン2009年版では，膵癌に対する術前治療の有用性を支持する論文が増加傾向にあるものの，十分な知見は蓄積されていないことから推奨度grade C1（科学的根拠はないが，行うよう勧められる）となっている．近年においても，膵癌術前治療に関する論文は数多く発表されてきているが，無作為化比較試験による十分なエビデンスはまだないのが現状であり，報告ごとにレジメンは異なっていて，また独特なものも多く，いずれも確立されたものではない．

参考文献

1）Evans DB, et al：Preoperative chemoradiation and pancreaticoduodenectomy for adenocarcinoma of the pancreas. Arch Surg 127：1335-1339, 1992

2）Spitz FR, et al：Preoperative and postoperative chemoradiation strategies in patients treated with pancreaticoduodenectomy for adenocarcinoma of the pancreas. J Clin Oncol 15：928-937, 1997

3）Yeo CJ, et al：Pancreaticoduodenectomy for pancreatic adenocarcinoma：postoperative adjuvant chemoradiation improves survival. A prospective, single-institution experience. Ann Surg 225：621-633, 1997

4）Heinrich S, et al：Neoadjuvant chemotherapy generates a significant tumor response in resectable pancreatic cancer without increasing morbidity. Results of a prospective phase Ⅱ trial. Ann Surg 248：1014-1022, 2008

5）Turrini O, et al：Neoadjuvant 5 fluorouracil-cisplatin chemoradiation effect on survival in patients with resectable pancreatic head adenocarcinoma：a ten-year single institution experience. Oncology 76：413-419, 2009

6）Gillen S, et al：Preoperative/neoadjuvant therapy in pancreatic cancer：a systematic review and meta-analysis of response and resection percentages. PLoS Med 7：e1000267, 2010

7）Tempero M, et al：National Comprehensive Cancer Network：Practice guidelines in oncology v. 1.2008：Pancreatic adenocarcinoma（www. nccn. org, 2009）

8）Varadhachary GR, et al：Borderline resectable pancreatic cancer：definitions, management, and role of preoperative therapy. Ann Surg Oncol 13：1035-1046, 2006

9）Katz MH, et al：Borderline resectable pancreatic cancer：the importance of this emerging stage of disease. J Am Coll Surg 206：833-846, 2008

10）Chun YS, et al：Defining venous involvement in borderline resectable pancreatic cancer. Ann Surg Oncol 17：2832-2838, 2010

11）Golcher H, et al：Preopetrative chemoradiation in adenocarcinoma of the pancreas. A single centre experience advocating a new treatment strategy. Eur J Surg Oncol 34：756-764, 2008

12）Satoi S, et al：Surgical results after preoperative chemoradiation therapy for patients with pancreatic cancer. Pancreas 38：282-288, 2009

13）Le Scodan R, et al：Preoperative chemoradiation in potentially resectable pancreatic adenocarcinoma：feasibility, treatment effect evaluation and prognostic factors, analysis of the SFRO-FFCD 9704 trial and literature review. Ann Oncol 20：1387-1396, 2009

14）Turrini O, et al：Neoadjuvant docetaxel-based chemoradiation for resectable adenocarcinoma of the pancreas：new neoadjuvant regimen was safe and provided an interesting pathologic response. Eur J Surg Oncol 36：987-992, 2010

15）Breslin TM, et al：Neoadjuvant chemotherapy for adenocarcinoma of the pancreas：treatment variables and survival duration. Ann Surg Oncol 8：123-132, 2001

16）Lawrence TS, et al：Delayed radiosensitization of human colon carcinoma cells after a brief exposure to 2', 2'-defluoro-2'-deoxycytidine（gemcitabine）. Clin Cancer Res 3：777-782, 1997

17）Okusaka T, et al：Phase Ⅱ study of radiotherapy combined with gemcitabine for locally advanced pancreatic cancer. Br J Cancer 91：673-677, 2004

18）Murphy JD, et al：Full-dose gemcitabine and concurrent radiotherapy for unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys 68：801-808, 2007

gemcitabine can be administered using limited-field radiotherapy. Strahlenther Onkol 183：301-306, 2007

20）Talamonti MS, et al：A multi-institutional phase Ⅱ trial of preoperative full-dose gemcitabine and concurrent radiation for patients with potentially resectable pancreatic carcinoma. Ann Surg Oncol 13：150-158, 2006

21）Brunner TB, et al：Primary resection versus neoadjuvant chemoradiation followed by resection for locally resectable or potentially resectable pancreatic carcinoma without distant metastasis. A multi-centre prospectively randomised phase Ⅱ-study of the interdisciplinary working group gastrointestinal tumours（AIO, ARO, and CAO）. BMC Cancer 7：41, 2007

22）Shinchi H, et al：Phase-Ⅰ trial of oral fluoropyrimidine anticancer agent（S-1）with concurrent radiotherapy in patients with unresectable pancreatic cancer. Br J Cancer 96：1353-1357, 2007

23）Ikeda M, et al：A phase Ⅰ trial of S-1 with concurrent radiotherapy for locally advanced pancreatic cancer. Br J Cancer 96：1650-1655, 2007

24）Sudo K, et al：Phase Ⅰ study of oral S-1 and concurrent radiotherapy in patients with unresectable locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 67：219-224, 2007

25）Kim HM, et al：Phase Ⅱ trial of S-1 and concurrent radiotherapy in patients with locally advanced pancreatic cancer. Cancer Chemother Phamacol 63：535-541, 2009

26）Sudo K, et al：Phase Ⅱ study of oral S-1 and concurrent radiotherapy in patients with unresectable locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 80：119-125, 2011

27）Reni M：Neoadjuvant treatment for resectable pancreatic cancer：time for phase Ⅲ testing. World J Gastroenterol 16：4883-4887, 2010

28）Palmer DH, et al：A randomized phase 2 trial of neoadjuvant chemotherapy in resectable pancreatic cancer：gemcitabine alone versus gemcitabine combined with cisplatin. Ann Surg Oncol 14：2088-2096, 2007

29）Varadhachary GR, et al：preoperative gemcitabine and cisplatin followed by gemcitabine-based chemoradiation for resectable adenocarcinoma of the pancreatic head. J Clin Oncol 26：3487-3495, 2008

30）Evans DB, et al：Preoperaitve gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head. J Clin Oncol 26：3496-3502, 2008

31）Ishikawa O, et al：Concomitant benefit of preoperative irradiation in preventing pancreas fistula formation after pancreatoduodenectomy. Arch Surg 126：885-889, 1991

32）Aiura K, et al：Beneficial effects of 5-fluorouracil and heparin-based portal infusion chemotherapy combined with mitomycin C and cisplatin after curative resection of pancreatic cancer. Pancreatology 10：250-258, 2010

33）Ohigashi H, et al：Feasibility and efficacy of combination therapy with preoperative and postoperative chemoradiation, extended pancreatectomy, and postoperative liver perfusion chemotherapy for locally advanced cancers of the pancreatic head. Ann Surg Oncol 12：629-636, 2005