联合放疗的胰腺癌新辅助/转化治疗进展

Progress in neoadjuvant/conversion therapy combined with radiotherapy for pancreatic cancer

摘要:

胰腺癌是一种侵袭性极高、预后极差的恶性肿瘤，手术切除是唯一可能实现治愈的手段。然而，由于大多数患者确诊时已处于局部进展或转移阶段，直接手术的可行性较低。近年来，新辅助/转化治疗已成为交界可切除及局部进展期胰腺癌的重要策略，可提高R₀切除率、改善生存预后。研究显示，FOLFIRINOX和吉西他滨联合白蛋白结合型紫杉醇是常用的新辅助化疗方案，前者适用于体能状态较好的患者，后者因毒性较低在更广泛人群中具有良好耐受性。此外，放疗（如立体定向体部放疗）可增强局部控制，提高肿瘤细胞杀伤率，并减少正常组织损伤，从而优化整体治疗效果。尽管该治疗模式展现出显著优势，但仍面临毒副作用管理、最佳治疗方案优化等挑战。未来研究将聚焦于个体化精准治疗，结合基因测序、影像组学等策略，以优化新辅助/转化治疗方案，并探索化疗、放疗与免疫或靶向治疗的联合应用，以期提高胰腺癌患者的长期生存率。本文总结了胰腺癌新辅助/转化治疗联合放疗的研究进展，并分析其在调控肿瘤生物学行为和优化治疗策略方面的应用前景。

Abstract:

Pancreatic cancer is a highly aggressive malignancy with a poor prognosis, and surgical resection remains the only potentially curative treatment. However, since most patients are diagnosed at a locally advanced or metastatic stage, the feasibility of upfront surgery is limited. In recent years, neoadjuvant and conversion therapy have emerged as crucial strategies for borderline resectable and locally advanced pancreatic cancer, aiming to increase the R₀ resection rate and improve survival outcomes. Studies have shown that FOLFIRINOX and gemcitabine plus nab-paclitaxel are commonly used neoadjuvant chemotherapy regimens, with the former being more suitable for patients with good performance status, while the latter is better tolerated across a broader patient population due to its lower toxicity. Additionally, radiotherapy, such as stereotactic body radiotherapy (SBRT), can enhance local tumor control, increase tumor cell eradication, and minimize damage to normal tissues, thereby optimizing overall treatment efficacy. Despite the significant advantages of this approach, challenges remain, including the management of toxic side effects and the optimization of treatment protocols. Future research will focus on personalized precision medicine, integrating genomic sequencing and radiomics to refine neoadjuvant/conversion therapy strategies and exploring the combination of chemotherapy, radiotherapy, immunotherapy, and targeted therapy to improve long-term survival in pancreatic cancer patients. This paper summarizes recent advancements in neoadjuvant/conversion therapy combined with radiotherapy for pancreatic cancer and discusses its potential role in modulating tumor biology and optimizing treatment strategies.