臨床外科67巻8号

2012年08月発行

特集 知っておきたい放射線・粒子線治療

膵癌に対する放射線治療の現況と展望

著者： 伊藤芳紀¹ 馬屋原博¹ 脇田明尚¹ 角美奈子¹ 師田まどか¹ 村上直也¹ 吉尾浩太郎¹ 稲葉浩二¹ 高橋加奈¹ 関井修平¹ 原田堅¹ 北口真由香¹ 山岸健太郎¹ 伊丹純¹

所属機関： ¹国立がん研究センター中央病院放射線治療科

ページ範囲：P.1004 - P.1010

【ポイント】

◆局所進行切除不能例に対し，新規抗癌剤併用化学放射線療法により治療成績が向上し，中長期的な生存も図ることができる．

◆放射線治療は，腫瘍に対する正確な照射と正常組織への線量低減を図るために，3次元治療計画を行うことが推奨される．

◆局所進行切除不能例に対する化学放射線療法前の導入化学療法や，切除例に対する補助化学放射線療法の有用性を検討する臨床試験が施行されている．

参考文献

1）日本膵臓学会膵癌診療ガイドライン改訂委員会（編）：科学的根拠に基づく膵癌診療ガイドライン，2009年版．金原出版，2009

2）Chauffert B, Mornex F, Bonnetain F, et al：Phase Ⅲ trial comparing intensive induction chemoradiotherapy（60Gy, infusional 5-FU and intermittent cisplatin）followed by maintenance gemcitabine with gemcitabine alone for locally advanced unresectable pancreatic cancer：definitive results of the 2000-01 FFCD/SFRO study. Ann Oncol 19：1592-1599, 2009

3）Loehrer PJ Sr, Feng Y, Cardenes H, et al：Gemcitabine alone versus gemcitabine plus radiotherapy in patients with locally advanced pancreatic cancer：an Eastern Cooperative Oncology Group trial. J Clin Oncol 29：4105-4112, 2011

4）Klaassen DJ, MacIntyre JM, Catton GE, et al：Treatment of locally unresectable cancer of the stomach and pancreas：a randomized comparison of 5-fluorouracil alone with radiation plus concurrent and maintenance 5-fluorouracil--an Eastern Cooperative Oncology Group study. J Clin Oncol 3：373-378, 1985

5）Ioka T, Nakamura S, Nishiyama K：A Randomized Phase Ⅱ Study of Gemcitabine 1000mg/msq and Concurrent Radiotherapy Comparing Gemcitabine Alone for Unresectable Locally Advanced Pancreatic Adenocarcinoma. Int J Radiat Oncol Biol Phys 78：S102, 2010

6）Ogawa K, Ito Y, Karasawa K, et al；JROSG Working Subgroup of Gastrointestinal Cancers：Patterns of radiotherapy practice for pancreatic cancer in Japan：results of the Japanese Radiation Oncology Study Group（JROSG）survey. Int J Radiat Oncol Biol Phys 77：743-750, 2010

7）Kalser MH, Ellenberg SS：Pancreatic cancer：Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg 120：899-903, 1985

8）Klinkenbijl JH, Jeekel J, Sahmoud T, et al：Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region：phase Ⅲ trial of the EORTC gastrointestinal tract cancer cooperative group. Ann Surg 230：776-784, 1999

9）Neoptolemos JP, Stocken DD, Friess H, et al：A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 350：1200-1210, 2004

10）Oettle H, Post S, Neuhaus P, et al：Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer：a randomized controlled trial. JAMA 297：267-277, 2007

11）Ueno H, Kosuge T, Matsuyama Y, et al：A randomised phase Ⅲ trial comparing gemcitabine with surgery-only in patients with resected pancreatic cancer：Japanese Study Group of Adjuvant Therapy for Pancreatic Cancer. Br J Cancer 101：908-915, 2009

12）Ogawa K, Karasawa K, Ito Y, et al；JROSG Working Subgroup of Gastrointestinal Cancers：Intraoperative radiotherapy for resected pancreatic cancer：a multi-institutional retrospective analysis of 210 patients. Int J Radiat Oncol Biol Phys 77：734-742, 2010

13）Karasawa K, Sunamura M, Okamoto A, et al：Efficacy of novel hypoxic cell sensitiser doranidazole in the treatment of locally advanced pancreatic cancer：long-term results of a placebo-controlled randomised study. Radiother Oncol 87：326-330, 2008

14）Kinoshita T, Uesaka K, Shimizu Y, et al：Effects of adjuvant intra-operative radiation therapy after curative resection in pancreatic cancer patients：results of a randomized study by 11 institutions in Japan. J Clin Oncol 27：15s,（suppl；abstr 4622）, 2009

15）Gillen S, Schuster T, Meyer Zum Büschenfelde C, et al：Preoperative/neoadjuvant therapy in pancreatic cancer：a systematic review and meta-analysis of response and resection percentages. PLoS Med 7：e1000267, 2010

16）National Comprehensive Cancer Network（NCCN）Practice Guidelines in Oncology for pancreatic adenocarcinoma. Version 2. 2012, http://www.nccn.org/clinical.asp

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

18）Sudo K, Yamaguchi T, Ishihara T, 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

19）Shinchi H, Maemura K, Mataki Y, et al：A phase Ⅱ study of oral S-1 with concurrent radiotherapy followed by chemotherapy with S-1 alone for locally advanced pancreatic cancer. J Hepatobiliary Pancreat Sci 19：152-158, 2012

20）Ikeda M, Okusaka T, Ito Y, et al：A Multicenter Phase Ⅱ Trial of S-1 with Concurrent Radiotherapy for Locally Advanced Pancreatic Cancer. Int J Radiat Oncol Biol Phys, 2012, in press

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

22）Yamazaki H, Nishiyama K, Koizumi M, et al：Concurrent chemoradiotherapy for advanced pancreatic cancer：1000mg/m2 gemcitabine can be administered using limited-field radiotherapy. Strahlenther Onkol 183：301-306, 2007

23）Crane CH, Winter K, Regine WF, et al：Phase Ⅱ study of bevacizumab with concurrent capecitabine and radiation followed by maintenance gemcitabine and bevacizumab for locally advanced pancreatic cancer：Radiation Therapy Oncology Group RTOG 0411. J Clin Oncol 27：4096-4102, 2009

24）Crane CH, Varadhachary GR, Yordy JS, et al：Phase Ⅱ trial of cetuximab, gemcitabine, and oxaliplatin followed by chemoradiation with cetuximab for locally advanced（T4）pancreatic adenocarcinoma：correlation of Smad4（Dpc4）immunostaining with pattern of disease progression. J Clin Oncol 29：3037-3043, 2011

25）Huguet F, André T, Hammel P, et al：Impact of chemoradiotherapy after disease control with chemotherapy in locally advanced pancreatic adenocarcinoma in GERCOR phase Ⅱ and Ⅲ studies. J Clin Oncol 25：326-331, 2007

26）Moureau-Zabotto L, Phélip JM, Afchain P, et al：Concomitant administration of weekly oxaliplatin, fluorouracil continuous infusion, and radiotherapy after 2 months of gemcitabine and oxaliplatin induction in patients with locally advanced pancreatic cancer：a Groupe Coordinateur Multidisciplinaire en Oncologie phase Ⅱ study. J Clin Oncol 26：1080-1085, 2008

27）Nakachi K, Furuse J, Kinoshita T, et al：A phase Ⅱ study of induction chemotherapy with gemcitabine plus S-1 followed by chemoradiotherapy for locally advanced pancreatic cancer. Cancer Chemother Pharmacol 66：527-534, 2010

28）Ch'ang HJ, Lin YL, Wang HP, et al：Induction chemotherapy with gemcitabine, oxaliplatin, and 5-fluorouracil/leucovorin followed by concomitant chemoradiotherapy in patients with locally advanced pancreatic cancer：a Taiwan cooperative oncology group phase Ⅱ study. Int J Radiat Oncol Biol Phys 81：e749-757, 2011

29）Mahadevan A, Miksad R, Goldstein M, et al：Induction gemcitabine and stereotactic body radiotherapy for locally advanced nonmetastatic pancreas cancer. Int J Radiat Oncol Biol Phys 81：e615-622, 2011

30）Abelson JA, Murphy JD, Minn AY, et al：Intensity-Modulated Radiotherapy for Pancreatic Adenocarcinoma. Int J Radiat Oncol Biol Phys 82：e595-601, 2012

31）Regine WF, Winter KA, Abrams RA, et al：Fluorouracil vs gemcitabine chemotherapy before and after fluorouracil-based chemoradiation following resection of pancreatic adenocarcinoma：a randomized controlled trial. JAMA 299：1019-1026, 2008

32）Abrams RA, Winter KA, Regine WF, et al：Failure to adhere to protocol specified radiation therapy guidelines was associated with decreased survival in RTOG 9704--a phase Ⅲ trial of adjuvant chemotherapy and chemoradiotherapy for patients with resected adenocarcinoma of the pancreas. Int J Radiat Oncol Biol Phys 82：809-816, 2012

33）Goodman KA, Regine WF, Dawson LA, et al：Radiation therapy oncology group consensus panel guidelines for the delineation of the clinical target volume in the postoperative treatment of pancreatic head cancer. Int J Radiat Oncol Biol Phys 83：901-908, 2012

34）Ohigashi H, Ishikawa O, Eguchi H, et al：Feasibility and efficacy of combination therapy with preoperative full-dose gemcitabine, concurrent three-dimensional conformal radiation, surgery, and postoperative liver perfusion chemotherapy for T3-pancreatic cancer. Ann Surg 250：88-95, 2009