Neoadjuvant preoperative chemoradiation in patients with pancreatic cancer.
OBJECTIVE
To assess the toxicity and efficacy of preoperative chemoradiation in pancreatic cancer.


METHODS
Between November 1996 and December 2001, 32 patients with biopsy-proven pancreatic adenocarcinoma (28 head; 4 body) were treated by chemoradiation consisting of either split-course therapy (two courses of 15 Gy separated by a 2-week break, n = 10) or standard-fractionation therapy (45 Gy during 5 weeks, n = 22). Concurrent chemotherapy included continuous infusion of 5-fluorouracil and a cisplatin bolus. Pancreatic resection was scheduled for 4-6 weeks after completion of chemoradiation treatment.


RESULTS
All 32 patients completed the chemoradiation protocol. Only 2 cases of Grade 3 toxicity (weight loss, vomiting) and one fatal Grade 4 infection occurred. Of the 32 patients, 19 underwent curative resection. Two patients had a complete pathologic response. One patient died 36 months after diagnosis of late treatment-related toxicity (acute superior mesenteric artery thrombosis) with no evidence of disease. The 2-year overall survival rate for the entire group and the resected patients was 37.3% (95% confidence interval 18.2-56.4%) and 59.3% (95% confidence interval 34.1-84.9%), respectively.


CONCLUSIONS
Preoperative chemoradiation with 5-fluorouracil and cisplatin is feasible and promising.
Magnin
Valerie
V
Department of Radiotherapy, Institut Paoli Calmettes, Marseille, France. magninv@marseille.fnclcc.fr
Moutardier
Vincent
V
Giovannini
Marie Helene
MH
Lelong
Bernard
B
Giovannini
Marc
M
Viret
Frederic
F
Monges
Genevieve
G
Bardou
Valerie Jeanne
VJ
Alzieu
Claude
C
Delpero
Jean Robert
JR
D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D018450:Disease Progression; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005240:Feasibility Studies; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D017538:Mesenteric Artery, Superior; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D011882:Radiotherapy, High-Energy / Q000009:adverse effects; D018805:Sepsis / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis; D013927:Thrombosis / Q000209:etiology; D016896:Treatment Outcome
D002945:Cisplatin; D005472:Fluorouracil