A phase II single institutional experience with preoperative radiochemotherapy in pancreatic adenocarcinoma.
BACKGROUND
Resection of pancreatic adenocarcinoma has a limited impact on survival. We hypothesized that delivering preoperative radiochemotherapy (RTCT) might enhance local control of the cancer and improve survival.


METHODS
Nineteen patients with localized pancreatic cancer (14 head and 5 body) were treated during the past 4 years with an intramural protocol consisting of continuous infusion of fluorouracile (5-FU: 650 mg/m(2)/D1-D5 and D21-D25 and Cisplatin 80 mg/m(2)/bolus D2 and D22 with preoperative external beam radiotherapy (RT) (30Gy split course RT or 45 Gy standard fractionation RT).


RESULTS
Four patients did not have surgical resection: Three patients were noted to have liver metastases and 1 patient developed peritoneal carcinomatosis. The remaining 15 patients had potentially curative resection (12 Whipple procedure and 3 distal subtotal pancreatectomy). There was no postoperative death. Pathologic findings showed five major responses including 2 patients with complete pathologic response. The overall median survival for the 19 study patients was 20 months. The median disease free and 2-year overall survival for the group with resection were 30 months and 52.3%.


CONCLUSIONS
Preoperative RTCT followed by resection is well-tolerated and safe for patients with localized pancreatic cancer. Major histological response occurred for 25% of patients. This approach could offer improvement in patient survival.
Moutardier
V
V
Institut Paoli-Calmettes, Marseille, France. moutardierv@marseille.fnclcc.fr
Giovannini
M
M
Lelong
B
B
Monges
G
G
Bardou
V J
VJ
Magnin
V
V
Charaffe-Jauffret
E
E
Houvenaeghel
G
G
Delpero
J R
JR
D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D018572:Disease-Free Survival; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011300:Preoperative Care; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D013995:Time; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome