title: Impact of preoperative chemoradiotherapy on survival in patients with resectable pancreatic cancer.
abstract: OBJECTIVE
  To explore whether preoperative chemoradiation therapy improves survival of patients with pancreatic cancer undergoing resectional surgery.
  
  
  METHODS
  Forty-seven patients with a malignant pancreatic tumor localized in the head or uncinate process of the pancreas underwent radical pancreatico-duodenectomy. Twenty-two received chemoradiation therapy (gemcitabine and radiation dose 50.4 Gy) before surgery (CRR) and 25 patients underwent surgery only (RO). The study was non-randomised. Patients were identified from a prospective database.
  
  
  RESULTS
  The median survival time was 30.2 mo in the CRR group and 35.9 mo in the RO group. No statistically significant differences were found in subclasses according to lymph node involvement, TNM stages, tumor size, or perineural invasion. The one, three and five year survival rates were 81%, 33% and 33%, respectively, in the CRR group and 72%, 47% and 23%, respectively, in the RO group. In ductal adenocarcinoma, the median survival time was 27 mo in the CRR group and 20 mo in the RO group. No statistically significant differences were found in the above subclasses. The one, three and five year survival rates were 79%, 21% and 21%, respectively, in the CRR group and 64%, 50% and 14%, respectively, in the RO group. The overall hospital mortality rate was 2%. The morbidity rate was 45% in the CRR group and 32% (NS) in the RO group.
  
  
  CONCLUSIONS
  Major multicenter randomized studies are needed to conclusively assess the impact of neoadjuvant treatment in the management of pancreatic cancer.
authors.affiliation: Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland. palvi.vento@pp.inet.fi
authors.forename: Pälvi
authors.initials: P
authors.lastname: Vento
authors.forename: Harri
authors.initials: H
authors.lastname: Mustonen
authors.forename: Timo
authors.initials: T
authors.lastname: Joensuu
authors.forename: Päivi
authors.initials: P
authors.lastname: Kärkkäinen
authors.forename: Eero
authors.initials: E
authors.lastname: Kivilaakso
authors.forename: Tuula
authors.initials: T
authors.lastname: Kiviluoto
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D004307:Dose-Response Relationship, Radiation; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D016577:Pancreaticoduodenectomy; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine