Surgical resection after radiochemotherapy in patients with unresectable adenocarcinoma of the pancreas.
BACKGROUND
The use of chemoradiotherapy for pancreatic cancer has been advocated for its potential ability to downstage locally advanced tumors. This article reports our experience with chemoradiotherapy for patients with unresectable, locally advanced pancreatic cancer (superior mesenteric artery or celiac axis encasement).


METHODS
Since 1998, 61 patients with radiographically unresectable, pathologically confirmed pancreatic adenocarcinoma have received standard fractionation radiation therapy (total dose, 45 Gy at 1.8 Gy, 5 d/wk) with chemotherapy, which included a continuous infusion of fluorouracil (5-FU: 650 mg/m(2)/D1-D5 and D21-D25) and cisplatin (80 mg/m(2)/bolus D2 and D22). Patients with tumor response at restaging CT scan underwent surgical exploration to determine whether the tumor was resectable.


RESULTS
Thirty-eight of 61 (62%) restaged patients demonstrated a disease progression. Twenty-three patients (38%) had an objective response, with, in all cases, persistence of arterial encasement. Twenty-three patients underwent exploratory operations after chemoradiotherapy, and 13 underwent standard Whipple resection. So 13 of 23 (56%) patients who had exploratory operation, or 23 of 61 (21%) patients, underwent surgical resection. With a median followup of 27 months, median survival for the resected patients was 28 months. Median survival was 11 months in the nonresponder group (n = 38) and 20 months in the group who received a palliative procedure (n = 10).


CONCLUSIONS
Locally advanced, unresectable pancreatic adenocarcinoma may be downstaged by chemoradiotherapy to allow for surgical resection. Patients whose cancer becomes resectable have a median survival at least comparable with survival after resection for initially resectable pancreatic adenocarcinoma.
Sa Cunha
Antonio
A
Department of Digestive Surgery, Groupe Hospitalier Sud, CHU Bordeaux, Pessac.
Rault
Alexandre
A
Laurent
Christophe
C
Adhoute
Xavier
X
Vendrely
Veronique
V
Béllannée
Geneviève
G
Brunet
René
R
Collet
Denis
D
Masson
Bernard
B
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D000465:Algorithms; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005472:Fluorouracil / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D009367:Neoplasm Staging; D010166:Palliative Care; D010179:Pancreas / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D011879:Radiotherapy Dosage; D016019:Survival Analysis; D013997:Time Factors
D002945:Cisplatin; D005472:Fluorouracil