title: [Histologic assessment of treatment effect of preoperative chemoradiation in patients presenting with resectable pancreatic adenocarcinoma].
abstract: OBJECTIVE
  Several phase II studies have shown the feasibility of neoadjuvant chemoradiation regimens for resectable localized pancreatic adenocarcinoma. However, there is to date no completed phase III study to validate this approach and treatment effects evaluation still remains an active area of investigation. From the mature results of the SFRO-FFCD 9704 trial, we explored the antitumoral effect of a 5-fluoro-uracil and cisplatin-based preoperative chemoradiation regimen, with a special highlight on the histopathological response and performed a literature review.
  
  
  METHODS
  Treatment consisted of concurrent radiotherapy (50 Gy within five weeks) and chemotherapy with 5-fluoro-uracil (300 mg/m(2)/day, five days/week, weeks 1-5) and cisplatin (20mg/m(2)/day, days 1-5 and 29-33), followed by surgical resection of the pancreatic tumour in patients without progression.
  
  
  RESULTS
  In all, 41 patients were enrolled, 26 patients (63%) underwent surgical resection with curative intent and 21 (80.7%) had R0 resection. A total of 13 of 26 specimens (50%) presented a major pathologic response (≥ 80% of severely degenerative cancer cells), with one complete pathologic response. The local recurrence and two-year survival rates were 4 and 32%, respectively, for the 26 operated patients.
  
  
  CONCLUSIONS
  Our results suggest that preoperative chemoradiation provides antitumoral effect associated with major histopathological response in 50% of patients and a high R0 resection rate. Evaluation of histopathological response to neoadjuvant chemoradiation may serve as a surrogate marker for treatment efficacy and further research is needed to determine new prognostic and predictive factors of treatment response.
authors.affiliation: Département de Radiothérapie, Centre René-Huguenin, 35 rue Dailly, 92210 Saint-Cloud, France.
authors.forename: R
authors.initials: R
authors.lastname: Le Scodan
authors.forename: F
authors.initials: F
authors.lastname: Mornex
authors.forename: C
authors.initials: C
authors.lastname: Partensky
authors.forename: C
authors.initials: C
authors.lastname: Mercier
authors.forename: P-J
authors.initials: PJ
authors.lastname: Valette
authors.forename: M
authors.initials: M
authors.lastname: Ychou
authors.forename: F
authors.initials: F
authors.lastname: Bibeau
authors.forename: J-Y
authors.initials: JY
authors.lastname: Scoazec
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy / Q000379:methods; D004334:Drug Administration Schedule; D005240:Feasibility Studies; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005602:France; D006801:Humans; D015182:Lymphatic Irradiation / Q000379:methods; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D011300:Preoperative Care / Q000379:methods; D011879:Radiotherapy Dosage; D016019:Survival Analysis
chemical_list: D002945:Cisplatin; D005472:Fluorouracil