Assessment of pathologic response after preoperative chemoradiotherapy and surgery in pancreatic adenocarcinoma.
OBJECTIVE
The benefits provided by preoperative chemoradiotherapy (CRT) in pancreatic ductular adenocarcinoma (PDA) are still controversial. However, in most reports from referral centers, improvement in local control and survival appears to be provided in selected patients. The aim of this retrospective study was to analyze the radiation-induced pathologic effects of preoperative CRT in patients with resectable PDA and determine the precise long-term outcome of the responding patients.


METHODS
Between November 1996 and October 2003, 61 patients underwent preoperative CRT for resectable PDA. The tumor location was the pancreatic head in 49 patients and pancreatic body in 12 patients. Of the 61 patients, 21 (34.5%) did not undergo surgery because of disease progression and 40 (65.5%) underwent pancreatic resection, including pancreaticoduodenectomy in 32 (80%) and distal pancreatectomy in 8 (20%).


RESULTS
A major pathologic response was noted in 9 patients, including three complete responses, and was found only in patients with tumor of the pancreatic head. The local control rate was similar in patients with and without a major pathologic response. Survival in patients with a major response was significantly greater than in those without a response or with a minor response.


CONCLUSIONS
Major tumor downstaging can be provided by preoperative CRT in patients with resectable cephalic PDA. Survival appears to be significantly improved in selected patients.
Moutardier
Vincent
V
Department of Surgical Oncology, Pancreas Tumor Study Group, Institut Paoli-Calmettes and Université de la Méditerranée, Marseille, France. moutardierv@marseille.fnclcc.fr
Magnin
Valérie
V
Turrini
Olivier
O
Viret
Frédéric
F
Hennekinne-Mucci
Stephanie
S
Gonçalves
Antony
A
Pesenti
Christian
C
Guiramand
Jérome
J
Lelong
Bernard
B
Giovannini
Marc
M
Monges
Geneviève
G
Houvenaeghel
Gilles
G
Delpero
Jean-Robert
JR
D000328:Adult; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome