I I percutaneous 125 I particles implanting PIP CT 11 treatment planning system TPS 125 I ~ I γ γ 2. X

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1 DOI: /j.cnki.jcr * advanced pancreatic carcinoma APC / 1 TNM T3N0M0 1 1 T- TNM AJCC 2 M- Tx M0 T0 M1 Tis T1 PanIN-3 2 cm T2 > 2 cm 0 Tis N0 M0 T3 ⅠA T1 N0 M0 T4 ⅠB T2 N0 M0 N- ⅡA T3 N0 M0 Nx ⅡB T1 T2 T3 N1 M0 N0 Ⅲ T4 N M0 N1 Ⅳ T N M1 NCCR CA A Cancer Journal for Clinicians ~ min % 80% HAIFU 1. percutaneous pancreas biopsy PPB PPB CT 2. 1 transarterial infusion chemotherapy TAI ~ 9 3 continuous transarterial infusion chemotherapy ctai bolus transarterial infusion chemotherapy btai 30 ~ 45 min ctai *

2 I I percutaneous 125 I particles implanting PIP CT 11 treatment planning system TPS 125 I ~ I γ γ 2. X DNA 125 I γ 0. 5 ~ 2. 0 cm h 0. 3 mg mg /q ~ 18 G CT / percutaneous radiofrequency /microwave ablation PRF /PMW PRF /PMW CT ROBIO 2. CT min 1 ~ mg CT mg /q8 50 ~ 90

3 ctai ~ ECOG > ~ < /L < /L 1 ~ 3 4 ~ ~ 1000 mg / 500 ~ 700 mg / mg 2 ~ 3 2. CA199 CEA CA PET /CT 500 ~ 700mg / HT ~ 6F RH Cobra Seldinger's ~ CT MRI 3. 1 UICC ~ 700mg / 2 1.

4 / / TPS 31 ~ QOL ECOG ~ 0. 8 mci / Cevc`s = + + / a. CT 2. 1 b. PET-CT a. TPS b ERCP K3 2 2 ~ 3 3mg im. qd I I > CT 125 I 4 < 3 6 PET-CT 125 I 5 > 5. 0 cm TPS mmol /L I 110 ~ 160 mgy 125 I 2. TPS 1 PTCD 1 CT TPS 2 3 CT I Ⅱ 125 I

5 ~ mg im. qd NCCN I 1 TPS < > 7 cm mmol /L B CT 1. 2 / mg DSA CT /MR T20 ~ T40 mm KJ W mm mm cm 3 T T T T T T ~ ~ T T T ~ ~ ~ 25 T ~ ~ T ~ ~ 60 87

6 CT 1 ~ 3 2% 100 ml 1 C mg / B CT 1. NCCN ~ cm 4 4. > 5. 0 cm 70 ~ 90 W 12 ~ 15 min B CT 1 PTCD ERCP 3 12 K3 2 2 ~ 3 3mg im. qd CT CT CT 6 PET-CT ~ DSA PTCD 2 ERCP 3 ~ 7

12 2018 3 UICC 2 4 PTCD ERCP 5-FU 20 3 ctai 1. / ROBO3 / mir-250b > 1. 0 cm 2. / ROBO3 /mir-250b 1. a. b. 125 I c. d. / 2. 1 2 3 4 / APC ctai ctai 4.

7 UICC 2 4 PTCD ERCP 5-FU 20 3 ctai 1. / ROBO3 / mir-250b > 1. 0 cm 2. / ROBO3 /mir-250b 1. a. b. 125 I c. d. / / APC ctai ctai 4. APC ctai ctai 3 43 ~ I 4 ctai 48 ~ ctai CT MRI I 1 3 ~ 7 TPS 125 I ~ 10 mm CT 1. a. b. 125 I CT c ~ 3 3. /

8 I 5 5. ctai- / -ctai ctai- / 125 I = log-rank 1 3. mrecist % ctai 41. 9% ctai 47. 5% 6 6 P = χ 2 ctai ctai % ~ 9 χ 2 ± ~ 90 ctai ctai P = ctai ctai % n = 215 ctai n = 210 ctai n = 185 n = 610 P ± ± ± ± TNM T3N1M T3N1M cm < ~ > C Child-Pugh A B C CEA I 2 ctai- 125 I -ctai 2. OS mean ± SD ± ± ± P 1. OS ± χ 2 P > ctai OS ± χ 2 P < OS 7. 1 ctai OS χ 2 P < OS OS ctai ctai χ 2

9 mrecist 1 P < OS log-rank P = ctai 125 I 6 % ctai ctai n = 215 n = 210 n = 185 n = 610 P CR + PR SD PD % ctai ctai n = 215 n = 210 n = 185 n = 610 P % ctai ctai n = 215 n = 210 n = 185 n = 610 P % ctai ctai n = 215 n = 210 n = 185 n = 610 P Edge SB Fritz AG Byrd DR et al. Purpose and Principles of Cancer Staging and Staging Forms. Cancer Staging Manual Chapter 1. Seventh Edition 2010 American Joint Committee on Cancer AJCC. 2 Sobin LH Gospodarowicz MK Wittekind C et al. TNM classification of malignant tumours. 7th ed. Chichester West Sussex UK Hoboken NJ Wiley-Blackwell Chen WQ Zheng RS Baade PD et al. Cancer Statistics in China CA Cancer J Clin Furukawa H Okada S Saisho H et al. Clinicopathologic features of small pancreatic adenocarcinoma. A collective study. Cancer Hidagom M. Pancreatic cancer. N Engl J Med Brugge WR. Endoscopic ultrasonography the current status. Gastroenterology

10 Schachter P Avni Y Gvirz G. The impact of laparoscopy and laparoscopic ultrasound on the management of pancreatic cystic lesions. Arch Surg Hess V Glimeus B Grawe P et al. CA 19-9 tumourmarker response to chemotherapy in patients with advanced pancreatic cancer enrolled in a randomised controlled trial. Lancet Oncol Maithels K Maloney S Winston C et al. Preoperative CA 19-9 and the yield of staging laparoscopy in patients with radiographically resectable pancreatic adenocarcinoma. Ann Surg Oncol Takahashi H Ohiashi H Ishikawa O et al. Serum CA19-9 alterations during preoperative gemcitabinebased chemoradiation therapy for resectable invasive ductal carcinoma of the pancreas as an indicator for therapeutic selection and survival. Ann Surg Goonnetilleke KS Sirwardena AK. Systematic review of carbohydrate antigen CA 19-9 as a biochemical marker in the diagnosis of pancreatic cancer. Eur J Surg Oncol Tempero MA Malafa MP Al-Hawary M et al. NCCN Guidelines Version Pancreatic Adenocarcinoma Version / 16 /16 c National Comprehensive Cancer Network Inc Nimura Y Nagino M Takao S et al. Standard versus extended lymphadenectomy in radical pancreatoduodenectomy for ductal adenocarcinoma of the head of the pancreas. Long-term results of a Japanese multicenter randomized controlled trial. Journal of Hepato-Biliary-Pancreatic. Sciences Jang JY Kang MJ Heo JS et al. A prospective randomized controlled study comparing outcomes of standard resection and extended resection including dissection of the nerve plexus and various lymph nodes in patients with pancreatic head cancer. Ann Surg Siegel R Ma J Zou Z et al. Cancer statistics. CA Cancer J Clin National Cancer Network. Clinical Practice Guidelines in Oncology. Pancreatic Adenocarcinoma. Version Available from http / /www. nccn. org /professionals /physician _ gls /f _ guidelines. asp. 21 Tol JAM Gouma DJ Bassi C et al. Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma A consensus statement by the International Study Group on Pancreatic Surgery ISGPS. Surgery Bockhorn M Uzunoglu FG Adham M et al. Borderline resectable pancreatic cancer A consensus statement by the International Study Group of Pancreatic Surgery ISGPS Surgery Hartwig W Vollmer CM Fingerhut A et al. Extended pancreatectomy in pancreatic ductal adenocarcinoma Definition and consensus of the International Study Group for Pancreatic Surgery ISGPS. 9.. Surgery Asbun HJ Conlon K Fernandez-Cruz L et al. When to performa 10. pancreatoduodenectomy in the absence of positive histology A consensus statement by the International Study Group of Pancreatic 218 DSA Surgery. Surgery Japan Pancreas Society. Classification of Pancreatic Carcinoma. Second English ed. Tokyo Kanehara & Co. Ltd Philip PA Benedetti J Corless CL et al. Phase III study comparing gemcitabine plus cetuximab versus gemcitabine in patients with advanced pancreatic adenocarcinoma Southwest Oncology Group directed intergroup trial S0205. J Clin Oncol Kindler HL Niedzwiecki D Hollis D et al. Gemcitabine plus bevacizumab compared with gemcitabine plus placebo in patients with advanced pancreatic cancer phase III trial of the Cancer and Leukemia Group B CALGB J Clin Oncol Moore MJ Goldstein D Hamm J et al. Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer a phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol Tanaka T Sakaguchi H Sho M et al. A novel interventional radiology technique for arterial infusion chemotherapy against advanced pancreatic Cancer. AJR Conroy T Desseigne F Ychou M et al. Groupe Tumeurs Digestives of Unicancer PRODIGE Intergroup. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med Kulke MH Tempero MA Niedzwiecki D et al. Randomized phase II study of gemcitabine administered at a fixed dose rate or in combination with cisplatin docetaxel or irinotecan in patients with metastatic pancreatic cancer CALGB J Clin Oncol Cunningham D Chau I Stocken DD et al. Phase III randomized comparison of gemcitabine versus gemcitabine plus capecitabine in patients with advanced pancreatic cancer. J Clin Oncol Louvet C Labianca R Hammel P et al. GERCOR GISCAD. Gemcitabine in combination with oxaliplatin compared with gemcitabine alone in locally advanced or metastatic pancreatic cancer results of a GERCOR and GISCAD phase III trial. J Clin Oncol Oettle H Richards D Ramanathan RK et al. A phase III trial of pemetrexed plus gemcitabine versus gemcitabine in patients with unresectable or metastatic pancreatic cancer. Ann Oncol Abou-Alfa GK Letourneau R Harker G et al. Randomized phase III study of exatecan and gemcitabine compared with gemcitabine alone in untreated advanced pancreatic cancer. J Clin Oncol

11 Tempero M Plunkett W Ruiz Van Haperen V et al. Randomized phase II comparison of dose-intense gemcitabine thirty-minute infusion and fixed dose rate infusion in patients with pancreatic adenocarcinoma. J Clin Oncol Menon KV Gomez D Smith AM et al. Impact of margin status on survival following pancreatoduo-denectomy for cancer the Leeds Pathology Protocol LEEPP. HPB Oxford CT 125 I CT 125 I Lundin J Roberts PJ Kuusela P et al. Prognostic significance of serum CA242 in pancreatic cancer. A comparison with CA19-9. Anticancer Res Balzano G DI Carlo V. Is CA 19-9 useful in the management of pancreatic cancer Lancet Oncol predicts overall survival in patients with pancreatic cancer treated with adjuvant chemoradiation a prospective validation by RTOG J Clin Oncol Han SL Cao CW Tang T et al. ROBO3 Promotes Growth and Metastasis of Pancreatic Carcinoma. Cancer Letters Liu T Wu GY Cheng JJ et al. Multifunctional lymph-targeted platform based on msio2 nanocomposites Combining PFOB for dual-mode imaging and DOX for cancer diagnose and treatment. Nano Research Vincent A Herman J Schulick R et al. Pancreatic cancer. Lancet Li D Xie K Wolffr R et al. Pancreatic cancer. Lancet Berger AC Garcia MJR Hoffman JP et al. Postresection CA 19-9 CT MRI DOI: /j.cnki.jcr CT CT 1 64 CT 2 16 CT 4 MRI 10 l. 5T T 3 PACS CT MRI CT MR CT MRI 4 ~ 6 9 ~ / / I lichueng@ 126. com

中国医学前沿杂志 ( 电子版 ) 2012 年第 4 卷第 5 期 (ptnm) 而言, 居于主导地位的国际抗癌联盟 (UICC) 和日本胃癌协会 (JGCA) 胃癌分期法已几经变更, 有时甚至引致一些专

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