title: Preoperative chemoradiation for patients with pancreatic cancer: toxicity of endobiliary stents.
abstract: OBJECTIVE
  A recent multicenter study of preoperative chemoradiation and pancreaticoduodenectomy for localized pancreatic adenocarcinoma suggested that biliary stent-related complications are frequent and severe and may prevent the delivery of all components of multimodality therapy in many patients. The present study was designed to evaluate the rates of hepatic toxicity and biliary stent-related complications and to evaluate the impact of this morbidity on the delivery of preoperative chemoradiation for pancreatic cancer at a tertiary care cancer center.
  
  
  METHODS
  Preoperative chemoradiation was used in 154 patients with resectable pancreatic adenocarcinoma (142 patients, 92%) or other periampullary tumors (12 patients, 8%). Patients were treated with preoperative fluorouracil (115 patients), paclitaxel (37 patients), or gemcitabine (two patients) plus concurrent rapid-fractionation (30 Gy; 123 patients) or standard-fractionation (50.4 Gy; 31 patients) radiation therapy. The incidences of hepatic toxicity and biliary stent-related complications were evaluated during chemoradiation and the immediate 3- to 4-week postchemoradiation preoperative period.
  
  
  RESULTS
  Nonoperative biliary decompression was performed in 101 (66%) of 154 patients (endobiliary stent placement in 77 patients and percutaneous transhepatic catheter placement in 24 patients). Stent-related complications (occlusion or migration) occurred in 15 patients. Inpatient hospitalization for antibiotics and stent exchange was necessary in seven of 15 patients (median hospital stay, 3 days). No patient experienced uncontrolled biliary sepsis, hepatic abscess, or stent-related death.
  
  
  CONCLUSIONS
  Preoperative chemoradiation for pancreatic cancer is associated with low rates of hepatic toxicity and biliary stent-related complications. The need for biliary decompression is not a clinically significant concern in the delivery of preoperative therapy to patients with localized pancreatic cancer.
authors.affiliation: Pancreatic Tumor Study Group, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4095, USA. ppisters@notes.mdacc.tmc.edu
authors.forename: P W
authors.initials: PW
authors.lastname: Pisters
authors.forename: W A
authors.initials: WA
authors.lastname: Hudec
authors.forename: J E
authors.initials: JE
authors.lastname: Lee
authors.forename: I
authors.initials: I
authors.lastname: Raijman
authors.forename: S
authors.initials: S
authors.lastname: Lahoti
authors.forename: N A
authors.initials: NA
authors.lastname: Janjan
authors.forename: T A
authors.initials: TA
authors.lastname: Rich
authors.forename: C H
authors.initials: CH
authors.lastname: Crane
authors.forename: R
authors.initials: R
authors.lastname: Lenzi
authors.forename: R A
authors.initials: RA
authors.lastname: Wolff
authors.forename: J L
authors.initials: JL
authors.lastname: Abbruzzese
authors.forename: D B
authors.initials: DB
authors.lastname: Evans
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001652:Bile Ducts / Q000473:pathology*; D003138:Common Bile Duct Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008099:Liver / Q000187:drug effects / Q000528:radiation effects; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D017239:Paclitaxel / Q000008:administration & dosage; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D000972:Antineoplastic Agents, Phytogenic; D003841:Deoxycytidine; D017239:Paclitaxel; D005472:Fluorouracil; D000093542:Gemcitabine