臨床外科70巻7号

2015年07月発行

特集 Neoadjuvant therapyの最新の動向—がんの治療戦略はどのように変わっていくのか

がん種別：術前補助療法の臨床的意義と今後の方向性

膵癌に対するneoadjuvant therapy

著者： 村田泰洋¹ 岸和田昌之¹ 伊佐地秀司¹

所属機関： ¹三重大学肝胆膵・移植外科

ページ範囲：P.850 - P.858

文献概要

【ポイント】
◆膵癌は，切除可能（R），境界切除可能（BR），切除不能（UR）に分類して治療方針を立てることが重要である．
◆R膵癌に対するneoadjuvant therapyの手術先行に対する優越性は，多施設共同前向き無作為化比較試験により検証される必要がある．
◆BR膵癌に対するneoadjuvant chemoradiotherapy（NCRT）は，R0切除率の向上に貢献し，治療成績の改善に結びつく可能性が示唆されている．
◆UR膵癌において，化学（放射線）療法に有効性を認めた症例に対して行う根治手術（adjuvant surgery）は，予後改善に優れていることが示されている．

参考文献

1）厚生労働省：平成25年人口動態統計月報年計（概数）の概況．http://www.mhlw.go.jp/toukei/saikin/hw/jinkou/geppo/nengai13/index.html

2）Egawa S, Toma H, Ohigashi H, et al：Japan Pancreatic Cancer Registry；30th year anniversary：Japan Pancreas Society. Pancreas 41：985-992, 2012

3）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

4）National Comprehensive Cancer Network（NCCN）Practice Guidelines for pancreatic cancer. ［Available at：http://www. nccn. org/clinical. asp（free registration is required for login）］.

5）Kato H, Usui M, Isaji S, et al：Clinical features and treatment outcome of borderline resectable pancreatic head/body cancer：a multi-institutional survey by the Japanese Society of Pancreatic Surgery. J Hepatobiliary Pancreat Sci 20：601-610, 2013

6）Nakao A, Kanzaki A, Fujii T, et al：Correlation between radiographic classification and pathological grade of portal vein wall invasion in pancreatic head cancer. Ann Surg 255：103-108, 2012

7）Katz MH, Marsh R, Herman JM, et al：Borderline resectable pancreatic cancer：need for standardization and methods for optimal clinical trial design. Ann Surg Oncol 20：2787-2795, 2013

8）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，2013年版．金原出版，2013

9）Evans DB, Varadhachary GR, Crane CH, et al：Preoperative gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head. J Clin Oncol 26：3496-3502, 2008

10）Varadhachary GR, Wolff RA, Crane CH, 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

11）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

12）Motoi F, Unno M, Takahashi H, et al：Influence of preoperative anti-cancer therapy on resectability and perioperative outcomes in patients with pancreatic cancer：Project study by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci 21：148-158, 2014

13）Katz MH, Fleming JB, Bhosale P, et al：Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators. Cancer 118：5749-5756, 2012

14）Donahue TR, Isacoff WH, Hines OJ, et al：Downstaging chemotherapy and alteration in the classic computed tomography/magnetic resonance imaging signs of vascular involvement in patients with pancreaticobiliary malignant tumors：influence on patient selection for surgery. Arch Surg 146：836-843, 2011

15）Kobayashi M, Mizuno S, Murata Y, et al：Gemcitabine-based chemoradiotherapy followed by surgery for borderline resectable and locally unresectable pancreatic ductal adenocarcinoma：significance of the CA19-9 reduction rate and intratumoral human equilibrative nucleoside transporter 1 expression. Pancreas 43：350-360, 2014

16）Andriulli A, Festa V, Botteri E, et al：Neoadjuvant/preoperative gemcitabine for patients with localized pancreatic cancer：a meta-analysis of prospective studies. Ann Surg Oncol 19：1644-1662, 2012

17）Satoi S, Yamaue H, Kato K, et al：Role of adjuvant surgery for patients with initially unresectable pancreatic cancer with a long-term favorable response to non-surgical anti-cancer treatments：results of a project study for pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepato-biliary Pancreat Sci 20：590-600, 2013

18）Murata Y, Mizuno S, Kishiwada M, et al：Impact of histological response after neoadjuvant chemoradiotherapy on recurrence-free survival in UICC-T3 pancreatic adenocarcinoma but not in UICC-T4. Pancreas 41：130-136, 2012

19）Murata Y, Hamada T, Kishiwada M, et al：Human equilibrative nucleoside transporter 1 expression is a strong independent prognostic factor in UICC T3-T4 pancreatic cancer patients treated with preoperative gemcitabine-based chemoradiotherapy. J Hepato-biliary Pancreat Sci 19：413-425, 2012

20）Murata Y, Isaji S, Kishiwada M, et al：Prognostic significance of human equilibrative nucleoside transporter1（hENT1）expression in pancreatic cancer patients treated with gemcitabine-based chemoradiotherapy and availability of endoscopic ultrasonography guided fine needle biopsy samples. 46th Annual Meeting of the Pancreas Club, May 18-19, 2012, p 33（http://pancreasclub.com/wp-content/uploads/2012finalprogram.pdf#）