膵癌に対する治療方針

摘要

脬癌に対する標準治療は，外科的切除，放射線治療，化学療法である.その中で根治が得られる 可能性が有るのは外科的切除であるが，局所癌遺度残度ROi'の根治切除が施行されても再発をきたす事も多く2'3)，生存率向上のため外科的切除に放射線治療，化学療法を加えた集学的治療が行われている.近年，塩酸ゲムシタビンが2001年4月に，TS-1が2006年8月に保険適応となり，これらの新规抗癌剤の導入により，化学療法の果たす役割が大きくなるとともに，今後の治療成績の向上に期待が持たれている.Pancreatic cancer remains one of the most difficult diseases to cure. Japan pancreas society guidelines for management of pancreatic cancer indicate therapeutic algorithm according to the clinical stage. For locally limited pancreatic cancer (cStage I, E, II in Japanese classification system), surgical resection is recommended, however prognosis is still poor. Major randomized controlled trials of resected pancreatic cancer indicates that adjuvant chemotherapy is superior to observation and gemcitabine is superior to 5-FU. For locally advanced resectable pancreatic cancer (cStage F a in JCS), we perform neoadjuvant chemoradiotherapy. Phase I study established a recommended dose of 800 mg gemcitabine and radiation dose of 36 Gy. For locally advanced nonresectable pancreatic cancer (cStage Va in JCS), chemoradiotherapy followed by chemotherapy is recommended. Although pancreatic cancer is chemotherapy resistant tumor, systemic chemotherapy is recommended for metastatic pancreatic cancer (cStage W b in JCS). Single-agent gemcitabine is the standard first line agent for the treatment of advanced pancreatic cancer. Meta-analysis of chemotherapy showed possibility of survival benefit of gemcitabine combination chemotherapy over gemcitabine alone. We hope gemcitabine combination chemotherapy or molecular targeted therapy will improve prognosis of pancreatic cancer in the future.