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1、局部進展期胰臟癌治療之新進展陳立宗M.D.,Ph.D國家衛生研究院癌症研究所國立成功大學附設醫院血液腫瘤內科高雄醫學大學附設醫院胃腸內科臺灣PancreasLiverGBDuodenumLiverPancreasStomachDuoA胰臟癌(PancreaticCancer)AdenocarcinomaoftheexocrinepancreasPancreasisaretro-peritonumorganRelativelysymptom-freeinearlystageEarlydissemination,smalltumordoesnothavetoearlydisea
2、seEasilymetastasizetoliverorencasegreatvesselMostcommonsymptoms,obstructivejaundice,BWlossandbackpainUsuallydiagnosedatadvancedstage＊InternationalAgencyforCancerResearch.GLOBOCAN2002.Availableat:http://www-dep.iarc.fr.AccessedSeptemberr8th,2009.CaseNo.MaleFemaleTotal(%)Global124,84110,4652
3、32,306(100.00)Asia52,63438,44891,082(39.21)NorthAmerica17,46817,45434,922(15.03)SouthAmerica6,6856,76213,447(5.79)WesternEurope10,6039,80320,406(8.78)EasternEurope15,86013,46329,323(12.62)NorthernEurope5,5885,82811,416(4.91)SouthernEurope8,9457,98316,928(7.29)Africa3,6473,7687,415(3.19)胰臟癌
4、之流行病學胰臟癌之臨床分期與預後UICCstageClinical/radiologicalcriteriaLong-termsurvivalMedianOSI~II可切除（Resectable,T1-3,selectedT4,NX,M0)NoSMA/CAencasementPatentSMV-PVconfluence20%13~20mIII局部進展期（Locallyadvanced,T4,NX-1,M0)SMA/CAinvolvementorOcclusionofSMV/SMPVconfluenceNA6~10mIV轉移性（Metastatic,anyT,anyN,M1)
5、NA3~6mSelectedT4,SMV/PVpartiallyinvolvedSMA/CA,上腸繫動脈(superiormesentericartery)/celiacaxisSMV/PV,上腸繫靜脈(superiormesentericvein)/門靜脈(portalvein)Managementofpancreaticcancer.Currentopinion&recommendationderivedfromthe8thWCGC,Barcelona,2006.VersylpeC,etal.AnnOncol2007;18:vii1-vii10Deoxycytidine
6、CytosinearabinosideGemcitabine（吉西他賓）HOHOHONH2NH2NH2HOH2CHOH2CHOH2COOONOOONNNNNFFHOStructureofdeoxycytidine,cytosinearabinosideandgemcitabineBurrisHA3rdetal.JCO1997;15:2403Gem1,000mg/m2,qweekx7/8weekthenx3/4week5-FU600mg/m2,weekly*p=0.0022;**p=0.0002;#p=0.0025Gemcitabine5-FUNo.ofpatients636
7、3Metastaticdiseases72%76%Objectivetumorresponserate:5.4%0%ClinicalBenefitresponserate:23.8%4.8%*Mediantimetotumorprogression:2.3mo0.9mo*Medianoverallsurvival:5.7mo4.4mo#6-monthsurvivalrate:46%29%12-monthsurvivalrate:18%2%第三期隨機分組臨床試驗比較吉西他賓(Gemcitabine)與5-FU治療晚期
