title: Assessment of pathologic response after preoperative chemoradiotherapy and surgery in pancreatic adenocarcinoma.
abstract: 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.
authors.affiliation: Department of Surgical Oncology, Pancreas Tumor Study Group, Institut Paoli-Calmettes and Université de la Méditerranée, Marseille, France. moutardierv@marseille.fnclcc.fr
authors.forename: Vincent
authors.initials: V
authors.lastname: Moutardier
authors.forename: Valérie
authors.initials: V
authors.lastname: Magnin
authors.forename: Olivier
authors.initials: O
authors.lastname: Turrini
authors.forename: Frédéric
authors.initials: F
authors.lastname: Viret
authors.forename: Stephanie
authors.initials: S
authors.lastname: Hennekinne-Mucci
authors.forename: Antony
authors.initials: A
authors.lastname: Gonçalves
authors.forename: Christian
authors.initials: C
authors.lastname: Pesenti
authors.forename: Jérome
authors.initials: J
authors.lastname: Guiramand
authors.forename: Bernard
authors.initials: B
authors.lastname: Lelong
authors.forename: Marc
authors.initials: M
authors.lastname: Giovannini
authors.forename: Geneviève
authors.initials: G
authors.lastname: Monges
authors.forename: Gilles
authors.initials: G
authors.lastname: Houvenaeghel
authors.forename: Jean-Robert
authors.initials: JR
authors.lastname: Delpero
mesh_terms: 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