胰腺癌治疗进展英文课件.ppt

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 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 treatment Or treatment may start late if there were complications Effect of Adjuvant Treatment Delay on Survival Iacobuzio-Donahue et al 2011 Cell Avoid Treatment Delay After Surgery 70% 40% Theoretical Advantages of Neoadjuvant Therapy Identify pts unlikely to benefit from surgery… During 2-3 mo treatment, up to 20% pts show metastases .. .. or develop poor performance status Is This an Advantage? Is this good or bad? Good.. They are spared surgery that would not have helped.. or Bad.. They missed their chance for resection and possible cure.. Neoadjuvant Therapy So why has it not become the standard approach? Several reasons are given Chemotherapy today has little effect in most pts Neoadjuvant Therapy At most, 1/3 of pts respond to neoadjuvant treatment.. So 2/3 would delay resection by 2-3 months, without effective treatment during that time.. Disease could progress Neoadjuvant Therapy Although today Chemother