Neoadjuvant chemoradiation for localized adenocarcinoma of the pancreas

Rebekah R. White, Herbert I. Hurwitz, Michael A. Morse, Catherine Lee, Mitchell S. Anscher, Erik K. Paulson, Marcia R. Gottfried, John Baillie, Malcolm S. Branch, Paul S. Jowell, Kevin M. McGrath, Bryan M. Clary, Theodore N. Pappas, Douglas S. Tyler

Research output: Contribution to journalArticle

177 Scopus citations

Abstract

Background: The use of neoadjuvant (preoperative) chemoradiotherapy (CRT) for pancreatic cancer has been advocated for its potential ability to optimize patient selection for surgical resection and to downstage locally advanced tumors. This article reports our experience with neoadjuvant CRT for localized pancreatic cancer. Methods: Since 1995, 111 patients with radiographically localized, pathologically confirmed pancreatic adenocarcinoma have received neoadjuvant external beam radiation therapy (EBRT; median, 4500 cGy) with 5-flourouracil-based chemotherapy. Tumors were defined as potentially resectable (PR, n = 53) in the absence of arterial involvement and venous occlusion and locally advanced (LA, n = 58) with arterial involvement or venous occlusion by CT. Results: Five patients (4.5%) were not restaged due to death (n = 3) or intolerance of therapy (n = 2). Twenty-one patients (19%) manifested distant metastatic disease on restaging CT. Twenty eight patients with initially PR tumors (53%) and 11 patients with initially LA tumors (19%) were resected after CRT. Histologic examination revealed significant fibrosis in all resected specimens and two complete responses. Surgical margins were negative in 72%, and lymph nodes were negative in 70% of resected patients. Median survival in resected patients has not been reached at a median follow-up of 16 months. Conclusions: Neoadjuvant CRT provided an opportunity for patients with occult metastatic disease to avoid the morbidity of resection and resulted in tumor downstaging in a minority of patients with LA tumors. Survival after neoadjuvant CRT and resection appears to be at least comparable to survival after resection and adjuvant (postoperative) CRT.

Original languageEnglish (US)
Pages (from-to)758-765
Number of pages8
JournalAnnals of surgical oncology
Volume8
Issue number10
DOIs
StatePublished - Dec 1 2001
Externally publishedYes

Keywords

  • Adenocarcinoma
  • Chemoradiotherapy
  • Neoadjuvant therapy
  • Pancreas

ASJC Scopus subject areas

  • Surgery
  • Oncology

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    White, R. R., Hurwitz, H. I., Morse, M. A., Lee, C., Anscher, M. S., Paulson, E. K., Gottfried, M. R., Baillie, J., Branch, M. S., Jowell, P. S., McGrath, K. M., Clary, B. M., Pappas, T. N., & Tyler, D. S. (2001). Neoadjuvant chemoradiation for localized adenocarcinoma of the pancreas. Annals of surgical oncology, 8(10), 758-765. https://doi.org/10.1245/aso.2001.8.10.758