title: Pathological and clinical impact of neoadjuvant chemoradiotherapy using full-dose gemcitabine and concurrent radiation for resectable pancreatic cancer.
abstract: OBJECTIVE
  The therapeutic options available as preoperative strategies for resectable pancreatic cancer have received worldwide attention. We have recently introduced neoadjuvant chemoradiotherapy (NACRT) to achieve local control and possibly complete cure. In this study, we have retrospectively evaluated its impact on pathology and the perioperative clinical course in addition to its safety.
  
  
  METHODS
  Sixty-one patients who received full-dose gemcitabine (1000 mg/m(2)) preoperatively with concurrent radiation (50 or 54 Gy) were evaluated. Seventy-one patients who received no preoperative therapy served as controls. Perioperative outcomes, postoperative complications, immunonutritional status, and the performance of adjuvant chemotherapy were compared.
  
  
  RESULTS
  Fifty-nine patients (97 %) completed NACRT. Toxicity was acceptable and the regimen was feasible as outpatient treatment. The perioperative outcomes were closely comparable to control. The rate of pancreatic fistula was lower and hospital stay was shorter in the NACRT group. The rate of lymph node metastasis and stage was lower in the NACRT group. Furthermore, R0 resection could be achieved in 92 % of patients treated with NACRT. Nutritional status decreased after NACRT and further deteriorated during adjuvant chemotherapy. The initiation of postoperative chemotherapy was delayed in the NACRT group.
  
  
  CONCLUSIONS
  Our current protocol of neoadjuvant chemoradiotherapy is feasible and substantially improves the pathology. However, it has some detrimental effects on postoperative nutritional status and performance of adjuvant chemotherapy. Furthermore, it should be noted that there is a possibility of arterial complications.
authors: Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan. m-sho@naramed-u.ac.jp
authors: Masayuki
authors: M
authors: Sho
authors: Takahiro
authors: T
authors: Akahori
authors: Toshihiro
authors: T
authors: Tanaka
authors: Shoichi
authors: S
authors: Kinoshita
authors: Tetsuro
authors: T
authors: Tamamoto
authors: Takeo
authors: T
authors: Nomi
authors: Ichiro
authors: I
authors: Yamato
authors: Daisuke
authors: D
authors: Hokuto
authors: Satoshi
authors: S
authors: Yasuda
authors: Chihiro
authors: C
authors: Kawaguchi
authors: Hideyuki
authors: H
authors: Nishiofuku
authors: Nagaaki
authors: N
authors: Marugami
authors: Yasunori
authors: Y
authors: Enomonoto
authors: Takahiko
authors: T
authors: Kasai
authors: Masatoshi
authors: M
authors: Hasegawa
authors: Kimihiko
authors: K
authors: Kichikawa
authors: Yoshiyuki
authors: Y
authors: Nakajima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D004305:Dose-Response Relationship, Drug; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology*; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000628:therapy; D012189:Retrospective Studies; D012264:Ribonucleotide Reductases / Q000037:antagonists & inhibitors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D007166:Immunosuppressive Agents; D003841:Deoxycytidine; D012264:Ribonucleotide Reductases; D000093542:Gemcitabine