title: Neoadjuvant chemoradiation with Gemcitabine for locally advanced pancreatic cancer.
abstract: BACKGROUND
  To evaluate efficacy and secondary resectability in patients with locally advanced pancreatic cancer (LAPC) treated with neoadjuvant chemoradiotherapy (CRT).
  
  
  METHODS
  A total of 215 patients with locally advanced pancreatic cancer were treated with chemoradiation at a single institution. Radiotherapy was delivered with a median dose of 52.2 Gy in single fractions of 1.8 Gy. Chemotherapy was applied concomitantly as gemcitabine (GEM) at a dose of 300 mg/m2 weekly, followed by adjuvant cycles of full-dose GEM (1000 mg/m2). After neoadjuvant CRT restaging was done to evaluate secondary resectability. Overall and disease-free survival were calculated and prognostic factors were estimated.
  
  
  RESULTS
  After CRT a total of 26% of all patients with primary unresectable LAPC were chosen to undergo secondary resection. Tumour free resection margins could be achieved in 39.2% (R0-resection), R1-resections were seen in 41.2%, residual macroscopic tumour in 11.8% (R2) and in 7.8% resection were classified as Rx. Patients with complete resection after CRT showed a significantly increased median overall survival (OS) with 22.1 compared to 11.9 months in non-resected patients. Median OS and disease-free survival (DFS) of all patients were 12.3 and 8.1 months respectively. In most cases the first site of disease progression was systemic with hepatic (52%) and peritoneal (36%) metastases.
  
  
  CONCLUSIONS
  A high percentage of patients with locally advanced pancreatic cancer can undergo secondary resection after gemcitabine-based chemoradiation and has a relative long-term prognosis after complete resection.
authors.affiliation: Department of Radiation Oncology, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. daniel.habermehl@med.uni-heidelberg.de
authors.forename: Daniel
authors.initials: D
authors.lastname: Habermehl
authors.forename: Kerstin
authors.initials: K
authors.lastname: Kessel
authors.forename: Thomas
authors.initials: T
authors.lastname: Welzel
authors.forename: Holger
authors.initials: H
authors.lastname: Hof
authors.forename: Amir
authors.initials: A
authors.lastname: Abdollahi
authors.forename: Frank
authors.initials: F
authors.lastname: Bergmann
authors.forename: Stefan
authors.initials: S
authors.lastname: Rieken
authors.forename: Jürgen
authors.initials: J
authors.lastname: Weitz
authors.forename: Jens
authors.initials: J
authors.lastname: Werner
authors.forename: Peter
authors.initials: P
authors.lastname: Schirmacher
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Jürgen
authors.initials: J
authors.lastname: Debus
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Combs
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods; D003841:Deoxycytidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000628:therapy*; D000093542:Gemcitabine
chemical_list: D000970:Antineoplastic Agents; D003841:Deoxycytidine; D000093542:Gemcitabine