title: Pancreatic head resectable adenocarcinoma: preoperative chemoradiation improves local control but does not affect survival.
abstract: BACKGROUND
  This study assesses the impact of preoperative chemoradiation on recurrence, surgical morbidity, histopathological data and survival in resectable adenocarcinoma of the pancreatic head.
  
  
  METHODS
  We carried out a retrospective study with an intention-to-treat analysis. From 1997 to 2006, 173 patients with resectable pancreas head carcinoma were treated in two reference centres in France using different treatment strategies.
  
  
  RESULTS
  Sixty-seven of 85 (79%) patients in the surgery-first (SF) group and 38 of 88 (43%) patients in the chemoradiation (CR) group underwent surgical resection (P < 0.001). Overall morbidity was 40% (15/38) in the CR group and 43% (29/67) in the SF group (P= 0.837). In the CR group, median tumour size was smaller (1.5 cm vs. 3.0 cm; P < 0.001) and fewer patients were node-positive (29% vs. 64%; P= 0.001) than in the SF group. There was less perineural (43% vs. 93%; P < 0.001), lymphatic and vascular (21% vs. 92%; P < 0.001) invasion in the CR group than in the SF group. In both groups, 89% of patients had recurrence (31/35 in the CR group and 57/64 in the SF group; P= 1.000), predominantly involving metastasis and carcinomatosis in the CR group (30/31 vs. 35/57; P < 0.001) and locoregional recurrence in the SF group (24/57 vs. 3/31; P= 0.002). Median survival for all patients and for resected patients in the CR and SF groups was, respectively, 15 months vs. 17 months, and 21 months vs. 18 months (P= non-significant).
  
  
  CONCLUSIONS
  Preoperative chemoradiation allows for good local control of the disease but does not increase survival, mainly for reasons of metastatic spread. Other options should be developed to improve both local and distant control of the disease.
authors.affiliation: Department of General Surgery and Liver Transplantation, La Conception Hospital, Marseille, France. louisebarbier@hotmail.fr
authors.forename: Louise
authors.initials: L
authors.lastname: Barbier
authors.forename: Olivier
authors.initials: O
authors.lastname: Turrini
authors.forename: Emilie
authors.initials: E
authors.lastname: Grégoire
authors.forename: Frédéric
authors.initials: F
authors.lastname: Viret
authors.forename: Yves-Patrice
authors.initials: YP
authors.lastname: Le Treut
authors.forename: Jean-Robert
authors.initials: JR
authors.lastname: Delpero
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011300:Preoperative Care / Q000379:methods*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents