Pancreatic ductal adenocarcinoma (PDAC) poses a significant challenge in oncology due to its advanced stage upon diagnosis and limited treatment options. Surgical resection, the primary curative approach, often results in poor long-term survival rates, leading to the exploration of alternative strategies like neoadjuvant therapy (NAT) and total neoadjuvant therapy (TNT). While NAT aims to enhance resectability and overall survival, there appears to be potential for improvement, prompting consideration of alternative neoadjuvant strategies integrating full-dose chemotherapy (CT) and radiotherapy (RT) in TNT approaches. TNT integrates chemotherapy and radiotherapy prior to surgery, potentially improving margin-negative resection rates and enabling curative resection for locally advanced cases. The lingering question: is more always better? This article categorizes TNT strategies into six main groups based on radiotherapy (RT) techniques: (1) conventional chemoradiotherapy (CRT), (2) the Dutch PREOPANC approach, (3) hypofractionated ablative intensity-modulated radiotherapy (HFA-IMRT), and stereotactic body radiotherapy (SBRT) techniques, which further divide into (4) non-ablative SBRT, (5) nearly ablative SBRT, and (6) adaptive ablative SBRT. A comprehensive analysis of the literature on TNT is provided for both borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC), with detailed sections for each.
胰腺导管腺癌（PDAC）因其诊断时多已进展至晚期且治疗选择有限，在肿瘤学领域构成重大挑战。手术切除作为主要根治手段，其长期生存率往往不佳，这促使人们探索新辅助治疗（NAT）和全新辅助治疗（TNT）等替代策略。尽管NAT旨在提高可切除性和总体生存率，但其效果仍有提升空间，因此促使学界考虑在TNT方案中整合足量化疗（CT）与放疗（RT）的替代性新辅助策略。TNT在术前联合应用化疗与放疗，可能提高切缘阴性切除率，并为局部晚期病例实现根治性切除创造条件。但核心问题在于：治疗强度是否越高越好？本文根据放疗技术将TNT策略分为六大类：（1）常规放化疗（CRT），（2）荷兰PREOPANC方案，（3）大分割消融调强放疗（HFA-IMRT），以及立体定向体部放疗（SBRT）技术——该技术进一步细分为（4）非消融性SBRT，（5）近消融性SBRT和（6）适应性消融SBRT。本文针对临界可切除胰腺癌（BRPC）和局部晚期胰腺癌（LAPC）的TNT研究文献进行了全面分析，并为每类技术设置详细章节展开论述。
Total Neoadjuvant Therapy in Localized Pancreatic Cancer: Is More Better?
肿瘤(癌症)患者之家