title: Surgical resection after radiochemotherapy in patients with unresectable adenocarcinoma of the pancreas.
abstract: 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.
authors.affiliation: Department of Digestive Surgery, Groupe Hospitalier Sud, CHU Bordeaux, Pessac.
authors.forename: Antonio
authors.initials: A
authors.lastname: Sa Cunha
authors.forename: Alexandre
authors.initials: A
authors.lastname: Rault
authors.forename: Christophe
authors.initials: C
authors.lastname: Laurent
authors.forename: Xavier
authors.initials: X
authors.lastname: Adhoute
authors.forename: Veronique
authors.initials: V
authors.lastname: Vendrely
authors.forename: Geneviève
authors.initials: G
authors.lastname: Béllannée
authors.forename: René
authors.initials: R
authors.lastname: Brunet
authors.forename: Denis
authors.initials: D
authors.lastname: Collet
authors.forename: Bernard
authors.initials: B
authors.lastname: Masson
mesh_terms: 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
chemical_list: D002945:Cisplatin; D005472:Fluorouracil