수술이 불가능한 진행성 췌장암 및 담도암 환자에서는 항암 화학 요법이 주 치료 방법이다. 황달이 동반되지 않고 전신 상태가 양호한 경우, 진단 후 1달 이내 항암 치료의 시작을 권고한다. 항암 화학 요법 시작 2-3개월마다 RECIST criteria에 따라 종양 크기 변화를 측정하고, 환자의 항암 화학 요법의 진행 여부를 결정한다. 항암 화학 요법 중 ECOG 3 또는 전신 상태 악화를 보이는 경우, 상의 후 항암 치료 중단을 고려하여야 한다(Fig. 3).

Chemotherapy is essential treatment in pancreatobiliary cancer patients. Knowing optimal time of chemotherapy initiation is important. Usually good performance status and general condition without jaundice is first recommendation for initiating chemotherapy. Good performance status is defined as Eastern Cooperative Oncology Group 0-1, with good biliary drainage and adequate nutritional intake. Percutaneous or endoscopic biliary drainage is recommended before chemotherapy in patient who shows high bilirubin level. The optimal timing of chemotherapy after diagnosis is not standardized but guideline recommends chemotherapy less 2 months after initial cancer diagnosis. Regard to chemotherapy response evaluation, Response Evaluation Criteria in Solid Tumors criteria is used per 2-3 months. Response Evaluation Criteria in Solid Tumors criteria evaluate the chemotherapy responsiveness. With regular tumor response, clinicians must determine whether patient can undergo chemotherapy continuously without complication. For example, Eastern Cooperative Oncology Group 3 or poor general condition make patient not to undergo chemotherapy and focus on end-of-life care. As a result, knowing about the start and stop of chemotherapy can help relieve the patient's symptoms, prolong survival and improve the quality of life.

서 론
본 론
    1. 항암 화학 요법의 시작
    2. 반응 평가
    3. 항암 화학 요법의 중단
결 론
요 약
REFERENCES

• 이희승(연세대학교 의과대학 내과학교실) | Hee Seung Lee (Department of Internal Medicine, Yonsei University College of Medicine) Corresponding author