Oncology Frontier: The role of adjuvant radiotherapy in the treatment of pancreatic cancer has had inconsistent results in several recent clinical trials. What do you think about the impact of postoperative concurrent radiotherapy and chemotherapy on survival and the prognosis for patients with pancreatic cancer? Which pancreatic cancer patients will be selected for concurrent chemoradiotherapy postoperation?

　　《肿瘤瞭望》：放疗在胰腺癌术后辅助治疗中的作用地位目前多个临床试验的结果不一致，请您谈谈术后同步放化疗对胰腺癌患者生存和预后的影响？您会对哪些患者选择术后同步放化疗？

　　Dr Weiss: The role of adjuvant radiation for the treatment of pancreas cancer is a somewhat controversial topic. In our center， patients who undergo surgical resection of pancreas cancer are recommended for some type of adjuvant therapy for the most part and then the question becomes chemotherapy plus or minus radiation therapy. I think your question really pertains as to whether they should get adjuvant radiation therapy. Patients who have pancreas cancer have the highest risk of dying from metastatic disease， so all patients in my opinion (and I think the data supports this) should get adjuvant chemotherapy following pancreatic resection. We reserve radiation therapy for patients who have more locally advanced tumors. For instance， those patients who have positive resection margins and for those who do have positive resection margins， whether it is microscopic or the rarer instance of macroscopic， that occasionally have nodal negative disease. So we have a bias at our institution to recommend radiation therapy post-operatively to patients. There has been a slight trend recently to go from standard radiation therapy to high-dose stereotactic radiation therapy. We have had some promising results with that which were presented here at this conference.

　　Dr Weiss:  胰腺癌的辅助放疗在一定程度上是个非常有争议的话题。在我们中心，我们都会做过外科手术切除的胰腺癌患者接受一些其他的辅助治疗，大多数情况下，我们的问题就在于化疗是否要加上放疗。我认为你的问题实际上就是胰腺癌患者是否需要接受放疗治疗。胰腺癌患者有很高的复发死亡风险，所以在我看来所有的患者都应该在手术切除胰腺肿瘤之后接受化疗，我想这也是有数据支持的。我们认为对于局部进展期的肿瘤放疗是需要的。比如那些怀疑切缘阳性或者病理确诊切缘阳性的患者，不论是不是显微镜下观察到的，即使淋巴结是阴性的，也是有必要做放疗的。所以我们机构更倾向于建议手术后患者接受放疗。同时也有从标准的放疗方案像高剂量的立体放疗方案的趋势。在这次会议上，我们也展示了一些激动人心的结果。

　　Oncology Frontier:  In locally advanced unresectable pancreatic cancer， are there any other factors could influence the prognosis of pancreatic cancer exception for tumor size， lymph node and distant metastasis?

　　《肿瘤瞭望》：在局部晚期不可切除胰腺癌中，除了肿瘤大小、淋巴结、远处转移影响预后之外，目前可能会影响患者预后的因素还有哪些？

　　Dr Weiss:  My presentation today was specifically discussing increasing the survival for patients with locally advanced pancreas cancer. Besides the traditional predictive factors such as tumor size， lymph node status and distant metastases， for patients with truly locally advanced unresectable pancreas cancer， there are some other factors that should be taken into account. Firstly， the patient’s performance status and whether they will tolerate chemotherapy or surgery. Some of the predictive factors would also include the response to neoadjuvant chemotherapy. We found that patients who consistently have good radiologic response to neoadjuvant therapy whether that is FOLFIRINOX or gemcitabine and abraxane， do seem to have a higher likelihood of having negative resection margins and also a higher likelihood of nodal negative disease. So I think response to systemic chemotherapy and occasionally if we treat with neoadjuvant radiation therapy， the response to radiation therapy prior to surgical resection can be a good predictor of overall prognosis.

　　Dr Weiss: 我今天的汇报中特别讨论了如何延长局部进展期胰腺癌患者的生存时间。对于真正的局部进展期胰腺癌患者，除了传统的那些预测因素，比如肿瘤大小、淋巴结阳性率、远处转移情况以外，一些其他的因素也应该包括进来。首先，患者的治疗状况以及是否他们可以耐受化疗和手术。一些预测因素应该还包括对新辅助化疗的反应情况。我们发现那些不论是对FOLFIRINOX 还是吉西他滨加紫杉醇的新辅助化疗方案敏感的胰腺癌患者，他们具有更高比例的阴性切缘和淋巴结阴性。所以我认为如果给患者新辅助化放疗治疗，放疗的反应比手术切除率能更好的预测患者总的生存期。

　　Oncology Frontier: Chemoradiation has been a conventional option for the management of unresectable locoregional pancreatic cancer; however， the benefits that upfront chemoradiation or subsequent chemoradiation after chemotherapy could bring to patients are still unclear up to now.  What do you think is the role of chemoradiation in the treatment of unresectable locoregional pancreatic cancer? How can we use multimodal therapy to improve the survival rate of locoregional pancreatic cancer?

　　《肿瘤瞭望》： 放化疗在局部不可切除的胰腺癌中是传统的治疗方式，但目前为止，前期的放化疗或者化疗之后的放化疗在不可切除的胰腺癌治疗中的作用不确定，您认为放化疗在局部不可切除的胰腺癌治疗中的作用如何？我们怎样好好的利用现有的多模式治疗手段提高局部晚期胰腺癌的预后？

　　Dr Weiss: The question is， what is the role of chemoradiation in truly unresectable locoregional pancreatic cancer? In our experience， patients are responding better and better to systemic therapy and radiation therapy. I presented some data today from our institution with approximately 100 patients， half of which received chemotherapy and half received stereotactic radiation therapy neoadjuvantly. Interestingly， we found that there was a very high complete pathologic response rate in those patients who received neoadjuvant radiation therapy. This would indicate that pancreatic cancer in certain patients is very responsive to both chemotherapy and occasionally radiation therapy. I think both of these modalities for truly locally advanced tumors should be standard of care. Then the question becomes whether other local therapies may be of benefit including ablations or possibly even irreversible electroporation. The verdict is still out on those therapies.

　　Dr Weiss: 问题就在于对于真正没办法手术切除的局部胰腺癌患者，化放疗的意义如何？在我们的实验研究中，患者对于系统化疗和放疗的效果越来越好。在我今天展示的我们研究中心的数据里，有接近100名胰腺癌患者，他们中有一半的患者接受的化疗，还有一半的患者接受了新辅助的立体定位放疗。有趣的是，我们发现在接受新辅助放疗组有更高比例的完全缓解率。这就表明对于一些特定的胰腺癌患者，化疗和放疗相结合的疗效很好。我认为对于局部进展期的肿瘤，化疗和放疗都应该得到同样的关注。但是问题又出现了，对于局部治疗比如消融或者不可逆的电穿孔，患者是否同样受益？对于这些治疗方法结论还没有确定。