Chemotherapy as initial treatment of locally advanced unresectable pancreatic cancer: a valid option?
BACKGROUND
Radio-chemotherapy is the standard treatment for locally advanced unresectable pancreatic cancer (LAPC). Chemotherapy has been shown to be effective in the treatment of metastatic disease and we therefore evaluated its use as a first-line treatment for LAPC.


METHODS
We carried out a retrospective analysis of all consecutive patients treated for LAPC (N=33) between July 1997 and April 2005, analysing the results of first-line chemotherapy (CT group) and radio-chemotherapy (RCT group) in this setting.


RESULTS
The first-line treatment was RCT in six patients (18.3%) and CT in 26 patients (78.8%). Secondary treatment was administered to nine patients of CT group with well-controlled disease: "closure" radio-chemotherapy for seven patients (26.9%) and secondary resection for three (12%). After a median follow-up of 27 months, 23 patients died (69.7%). Overall survival was 13.8 months [95% CI: 10.1-19.4] for the whole population, 9.5 months [95% CI: 4.6-] for the RCT and 18.0 months [95% CI: 12.4-25.5] for the CT. Overall survival for the CT patients undergoing secondary surgery or "consolidation" radio-chemotherapy was 28.8 months [95% CI: 13.8-].


CONCLUSIONS
First-line chemotherapy is a valid option for LAPC treatment, making it possible to identify the patients who may benefit from secondary resection or radio-chemotherapy.
Bachet
Jean-Baptiste
JB
Assistance Publique Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt, UVSQ - Association ADEBIOPHARM ER48, Paris.
Mitry
Emmanuel
E
Lepère
Céline
C
Declety
Gilles
G
Vaillant
Jean-Nicolas
JN
Parlier
Henri
H
Otmezguine
Yves
Y
Julie
Catherine
C
Penna
Christophe
C
Housset
Martin
M
Nordlinger
Bernard
B
Rougier
Philippe
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000628:therapy*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies
D000970:Antineoplastic Agents