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1、LocallyAdvancedPancreaticCancer:CurrentTherapeuticApproach【关键词】Pancreatic,cancerKeyoleculartargetedtherapyABSTRACTEventhoughpancreaticcanceraccountsforonly2%ofallcancerdiagnosesintheU.S.,itisthefourth-leadingcauseofcancerdeathandoneofthemostdifficultmalignanciestomanage.Becauseoftheusuall
2、ylateonsetofsymptoms,only10%15%ofpatientspresentaining85%90%presentetastaticdisease.Despitealackofconsistentevidencefrompreviousclinicaltrials,chemotherapyinadditiontoradiationtherapyisthemostmonlyusedapproachintreatinglocallyadvancedpancreaticcancer.Themostappropriatechemotherapyinbinati
3、oncitabine,andnoveltrendstopreventresistanceandenhanceefficacyincorporatebiologicallytargetedagents.Thispaperrevieanagementoptions,controversies,andongoingandfuturedirectionsforthetreatmentoflocallyadvancedadenocarcinomaofthepancreas.INTRODUCTIONTheAmericanCancerSocietyestimatedthatthereo
4、stmoncauseofcancermortality[1].Despitecontinuingadvancesindiagnosticimagingandstaging,improvementsinradiationtherapytechniques,andavailabilityofneictherapies,thesurvivalandmortalityfromPChaveremainedrelativelyconstant.Forallstagesbined,the1-yearsurvivalrateisaround20%,andtheoverall5-years
5、urvivalratehasremaineddismallypoorat<5%[1].pletesurgicalresectionremainstheonlycurativetreatmentforPC.Studiesfromhigh-volumecentersalstagingreportuptoa15%20%5-yearsurvivalrateinpatientsundergoingresection[2,3].Unfortunately,becauseofthetypicallylateonsetofsymptoms,onlyabout15%20%ofcase
6、sofPCareamenabletosurgicalresectionatthetimeofdiagnosis.Oftheremaining80%85%ofpatients,40%presentediansurvivaltime(MST)of611months,andtheother45%ofpatientspresentetastaticdisease,onths[46].Inthe2003AmericanJointmitteeforCancer(AJCC)stagingsystem(Table1)[7]T1T3lesions,stagegrouping0IIB,ful
7、fillcriteriaforlocalresectability;ontheotherhand,T4lesions(involvementoftheceliacaxisorthesuperiormesentericarteryorstageIIIdisease)asetastaticdisease(stageIV)areconsideredunresectable.Preoperatively,intheabsenceofconfirmedmetastaticdisease,thefolloineunresectabilit
