《胰腺癌治疗进展英》PPT课件

HowardA.Reber,MDProfessorofSurgeryUCLASchoolofMedicine,PancreaticCancerSurgicalApproachintheUSA-2014,AgiHirshbergCenterforPancreaticDiseasesatUCLA,PancreaticCancerEpidemiology,2014-46,420newcasesinUSA2014-39,590deaths4thmostcommoncancerkiller2ndmostcommonGIcancerkiller(colon#1),PancreaticCancerEpidemiology,NewCancerDeaths,UnitedStates,2014.,PancreaticCancerEpidemiology,Incidenceincreasing1%yearly,PancreaticCancerEpidemiology,85%ofnewcasesareadvancedLocallyadvanced:bloodvessels(StageIII)Distantspreadtoliver,lungs(StageIV),LatePresentation-PoorSurvival,Howlanderetal,SEERCancerStatisticsReview2012.AmericanCancerSociety,CancerFacts146(7):836-843.DonahueTR,ReberHAetal,When/WhethertoOperate?CTImaging,PV,SMA,SV,SMV,IMV,LRV,LGA,SA,HA,Pancreas,Adrenal,DownstagingofPaCaSurvival,25+survivors5-17yearsObservedfive-yearsurvivalrate:28%13morecloseto5yrswithnorecurrencePossiblefiveyearsurvivalrate:53%,AdjuvantTherapy,Treatmentgivenaftersurgery(Whipple/distal)EfforttoeradicateanyremainingmicroscopictumorStandardapproach,NeoadjuvantTherapy,Treatmentgivenbeforesurgeryinptswithresectabledisease(StageIandII)SomeinUSArecommendthisinsteadofsurgeryfirstAdvantagesanddisadvantages,TheoreticalAdvantages,Almostallptshavemicrometastaticdiseaseatdiagnosis1cm-28%havemetastases2cm-73%3cm-94%Soalmostallptscouldbenefit.,Iacobuzio-Donahueetal2011Cell,TheoreticalAdvantages,Ifgivenaftersurgery,upto25%maynotbetreatedatall.Ifgivenbefore,morelikelytobephysicallyfitandabletotoleratetreatmentOrtreatmentmaystartlateiftherewerecomplications,EffectofAdjuvantTreatmentDelayonSurvival,Iacobuzio-Donahueetal2011Cell,AvoidTreatmentDelayAfterSurgery,70%,40%,TheoreticalAdvantagesofNeoadjuvantTherapy,IdentifyptsunlikelytobenefitfromsurgeryDuring2-3motreatment,upto20%ptsshowmetastases.ordeveloppoorperformancestatus,IsThisanAdvantage?,Isthisgoodorbad?Good.Theyaresparedsurgerythatwouldnothavehelped.orBad.Theymissedtheirchanceforresectionandpossiblecure.,NeoadjuvantTherapy,Sowhyhasitnotbecomethestandardapproach?SeveralreasonsaregivenChemotherapytodayhaslittleeffectinmostpts,NeoadjuvantTherapy,Atmost,1/3ofptsrespondtoneoadjuvanttreatment.So2/3woulddelayresectionby2-3months,withouteffectivetreatmentduringthattime.Diseasecouldprogress,NeoadjuvantTherapy,AlthoughtodayChemotherapyhaslittleeffectinmostpts.Thiscouldchangewithmoreeffectiveneoadjuvantregimens.Orwiththeabilitytoselectivelychoosearegimenspecificforthemolecularfeaturesofeachtumor,NeoadjuvantRadioTherapy,RadiationTherapy(RTx)ofunclearvalueinmostptsRTxdefinitelydecreaseslocalrecurrenceofcancerButitdoesnotincreasesurvivalinmost.Mostptsdieofdistantdisease(liver,lung,peritoneal)evenwhenlocalrecurrenceislowSoneoadjuvantRTxalsoisnotdonebymostUSAsurgeons,SurgeryinUSA-2014,FurthermajorsurgicaladvancesunlikelyMortalityrate1%;morbiditystillhighImprovedoutcomeslikelytocomefrommoreeffectivedrugsincombinationwithsurgeryNeoadjuvanttherapywillbeusedmoreMoredownstagingwithbetterdrugs,DavidGeffenSchoolofMedicineatUCLA1955-2014,RonaldReaganUCLAMedicalCenter,Opene