文档介绍：胰腺癌治疗进展英文ppt课件
No Surgery
If..
Major blood vessels involved (Stage III)
Distant metastases (Stage IV)
Some Stage Ivein or artery
UNRESECTABLE
Criteria for Resection
Why not resect the involved blood vessels?
Criteria for Resection
Those with vessel invasion have extensive tumor with microscopic spread that cannot be removed completely
Not seen on preop scans, but experience tells us it’s there
If we resect Stage III tumors, the cancer comes back quickly
“Downstaging” of PaCa
Pts given chemotherapy 6-12 mos
We try to kill the microscopic tumor first
Re-evaluation by CT, CA19-9
Resection then possible in some
First reported by our group (1998)
Now more widely done in USA…
So..
Effect of Chemotherapy on Tumor
Tumor: x
PV invasion (+)
Tumor: x (57% reduction)
PV invasion (-)
Before
After
Initial scan shows SMA involvement
6 mos scan looks similar
But patient felt well and CA19-9 fell from 840 to normal..
Arch Surg. 2011;146(7):836-843. Donahue TR, Reber HA et al
When/Whether to Operate? CT Imaging
PV
SMA
SV
SMV
IMV
LRV
LGA
SA
HA
Pancreas
Adrenal
Downstaging of PaCa
Survival
25+ survivors 5-17 years
Observed five-year survival rate: 28%
13 more close to 5 yrs with no recurrence
Possible five year survival rate: 53%
Adjuvant Therapy
Treatment given after surgery (Whipple/distal)
Effort to eradicate any remaining microscopic tumor
Standard approach
Neoadjuvant Therapy
Treatment given before surgery in pts with resectable disease (Stage I and II)
Some in USA recommend this instead of surgery first
Advantages and disadvantages
Theoretical Advantages
Almost all pts have micrometastatic disease at diagnosis …
1 cm - 28% have metastases
2 cm - 73%
3 cm - 94%
So almost all pts could benefit..
Iacobuzio-Donahue et al 2011 Cell
Theoretical Advantages
If given after surgery, up to 25% may not be treated at all..
If given before, more likely to be physically fit and able to tolerate treatme