Neoadjuvant Chemoradiotherapy for Adenocarcinoma of the Pancreas: Treatment Variables and Survival Duration (original) (raw)
Abstract
**Background:**For patients with potentially resectable pancreatic cancer, the poor outcome associated with resection alone and the survival advantage demonstrated for combined-modality therapy have stimulated interest in preoperative chemoradiotherapy. The goal of this study was to analyze the effects of different preoperative chemoradiotherapy schedules, intraoperative radiation therapy, patient factors, and histopathologic variables on survival duration and patterns of treatment failure in patients who underwent pancreaticoduodenectomy for adenocarcinoma of the pancreatic head.
**Methods:**Data on 132 consecutive patients who received preoperative chemoradiation followed by pancreaticoduodenectomy for adenocarcinoma of the pancreatic head between June 1990 and June 1999 were retrieved from a prospective pancreatic tumor database. Patients received either 45.0 or 50.4 Gy radiation at 1.8 Gy per fraction in 28 fractions or 30.0 Gy at 3.0 Gy per fraction in 10 fractions with concomitant infusional chemotherapy (5-fluorouracil, paclitaxel, or gemcitabine). If restaging studies demonstrated no evidence of disease progression, patients underwent pancreaticoduodenectomy. All patients were evaluated with serial postoperative computed tomography scans to document first sites of tumor recurrence.
**Results:**The overall median survival from the time of tissue diagnosis was 21 months (range 19–26, 95%CI). At last follow-up, 41 patients (31%) were alive with no clinical or radiographic evidence of disease. The survival duration was superior for women (P = .04) and for patients with no evidence of lymph node metastasis (P = .03). There was no difference in survival duration associated with patient age, dose of preoperative radiation therapy, the delivery of intraoperative radiotherapy, tumor grade, tumor size, retroperitoneal margin status, or the histologic grade of chemoradiation treatment effect.
**Conclusion:**This analysis supports prior studies which suggest that the survival duration of patients with potentially resectable pancreatic cancer is maximized by the combination of chemoradiation and pancreaticoduodenectomy. Furthermore, there was no difference in survival duration between patients who received the less toxic rapid-fractionation chemoradiotherapy schedule (30 Gy, 2 weeks) and those who received standard-fractionation chemoradiotherapy (50.4 Gy, 5.5 weeks). Short-course rapid-fractionation preoperative chemoradiotherapy combined with pancreaticoduodenectomy, when performed on accurately staged patients, maximizes survival duration and is associated with a low incidence of local tumor recurrence.
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REFERENCES
- Gastrointestinal Tumor Study Group. Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer. Cancer 1987;59:2006–10.
Google Scholar - Kalser MH, Ellenberg SS. Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg 1985; 120: 899–903.
CAS PubMed Google Scholar - Yeo CJ, Abrams RA, Grochow LB, et al. Pancreaticoduodenectomy for pancreatic adenocarcinoma: postoperative adjuvant chemoradiation improves survival. A prospective, single-institution experience. Ann Surg 1997; 225: 621–33.
Google Scholar - Klinkenbijl JH, Jeekel J, Sahmoud T, et al. Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC Gastrointestinal Tract Cooperative Group. Ann Surg 1999; 230: 776–82.
Article CAS PubMed Google Scholar - Neoptlemos J, Dunn J, Moffitt D, et al. ESPAC-1 interim results: a European, randomized study to assess the roles of adjuvant chemotherapy (5FU+folinic acid) and adjuvant chemoradiation (40 Gy+5FU) in resectable pancreatic cancer. Proc Am Soc clin Oncol 2000; 19: 238(abstract).
Google Scholar - Evans DB, Abbruzzese JL, Rich TA. Cancer of the pancreas. In: DeVitaVTJr, Hellman S, Rosenberg SA, eds. Cancer: Principles and Practice of Oncology. 5th ed. Philadelphia: Lippincott, 1997: 1054–87.
Google Scholar - Staley CA, Lee JE, Cleary KR, et al. Preoperative chemoradiation, pancreaticoduodenectomy, and intraoperative radiation therapy for adenocarcinoma of the pancreatic head. Am J Surg 1996; 171: 118–24; discussion 124–5.
Google Scholar - Foo ML, Gunderson LL, Nagorney DM, et al. Patterns of failure in grossly resected pancreatic ductal adenocarcinoma treated with adjuvant irradiation ±5-fluorouracil. Int J Radiat Oncol Biol Phys 1993; 26: 483–9.
Google Scholar - Hoffman JP, Lipsitz S, Pisansky T, Weese JL, Solin L, Benson AB III. Phase II trial of preoperative radiation therapy and chemotherapy for patients with localized, resectable adenocarcinoma of the pancreas: an Eastern Cooperative Oncology Group. J Clin Oncol 1998; 16: 317–23.
CAS PubMed Google Scholar - Whittington R, Bryer MP, Haller DG, Solin LJ, Rosato EF. Adjuvant therapy of resected adenocarcinoma of the pancreas. Int J Radiat Oncol Biol Phys 1991; 21: 1137–43.
Google Scholar - Spitz FR, Abbruzzese JL, Lee JE, et al. Preoperative and postoperative chemoradiation strategies in patients treated with pancreaticoduodenectomy for adenocarcinoma of the pancreas. J Clin Oncol 1997; 15: 928–37.
CAS PubMed Google Scholar - Evans DB, Rich TA, Byrd DR, et al. Preoperative chemoradiation and pancreaticoduodenectomy for adenocarcinoma of the pancreas. Arch Surg 1992; 127: 1335–9.
CAS PubMed Google Scholar - Pisters PW, Abbruzzese JL, Janjan NA, et al. Rapid-fractionation preoperative chemoradiation, pancreaticoduodenectomy, and intraoperative radiation therapy for resectable pancreatic adenocarcinoma. J Clin Oncol 1998; 16: 3843–50.
Google Scholar - Rich TA, Janjan NA, Abbruzzese JL, Evans DB. Letter to the editor. J Clin Oncol 1997; 15: 3292–93.
Google Scholar - Fuhrman GM, Charnsangavej C, Abbruzzese JL, et al. Thin-section contrast-enhanced computed tomography accurately predicts the resectability of malignant pancreatic neoplasms. Am J Surg 1994; 167: 104–11.
Google Scholar - Pisters PWT, Abbruzzese JL, Janjan NA, et al. Comparative toxicities of preoperative paclitaxel vs. 5-fluorouracil based rapid fractionation chemoradiation for resectable pancreatic adenocarcinoma. Proc Am Soc Clin Oncol 1999; 18: 224(abstract).
Google Scholar - Wolff RA, Evans DB, Gravel DM, et al. Phase I trial of gemcitabine combined with radiation for treatment of locally advanced pancreatic adenocarcinoma. Proc Am Soc Clin Oncol 1998; 17: 283(abstract).
Google Scholar - Evans DB, Lee JE, Pisters PWT. Pancreaticoduodenectomy (Whipple operation) and Total Pancreatectomy for Cancer. In: Nyhus LM, Baker RJ, Fischer JE, eds. Mastery of Surgery. 3rd ed. New York: Little Brown 1997: 1233–49.
Google Scholar - Bold RJ, Charnsangavej C, Cleary KR, et al. Major vascular resection as part of pancreaticoduodenectomy for cancer: radiologic, intraoperative, and pathologic analysis. J Gastrointest Surg 1999; 3: 233–43.
Article CAS PubMed Google Scholar - Evans DB, Termuhlen PM, Byrd DR, Ames FC, Ochran TG, Rich TA. Intraoperative radiation therapy following pancreaticoduodenectomy. Ann Surg 1993; 218: 54–60.
Google Scholar - Staley CA, Cleary KR, Abbruzzese JL, et al. The need for standardized pathologic staging of pancreaticoduodenectomy specimens. Pancreas 1996; 12: 373–80.
Google Scholar - Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 185: 1457–81.
Google Scholar - Geer RJ, Brennan MF. Prognostic indicators for survival after resection of pancreatic adenocarcinoma. Am J Surg 1993; 165: 68–72.
CAS PubMed Google Scholar - Nitecki SS, Sarr MG, Colby TV, van Heerden JA. Long-term survival after resection for ductal adenocarcinoma of the pancreas. Is it really improving? Ann Surg 1995; 221: 59–66.
Google Scholar - Yeo CJ, Cameron JL, Lillemoe KD, Pitt HA. Six hundred and fifty consecutive pancreaticoduodenectomies in the 1990s. Ann Surg 1997; 226: 248–57.
Article CAS PubMed Google Scholar - Pedrazzoli S, DiCarlo V, Dionigi R, et al. Standard versus extended lymphadenectomy with pancreaticoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas. A multicenter, prospective, randomized study. Ann Surg 1998; 228: 508–17.
Article CAS PubMed Google Scholar - Willett CG, Lewandrowski K, Warshaw AL, Efird J, Compton CC. Resection margins in carcinoma of the head of the pancreas. Implications for radiation therapy. Ann Surg 1993; 217: 144–8.
Google Scholar
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Authors and Affiliations
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
Tara M. Breslin MD, Dana B. Harbison MD, Marina E. Jean MD, Alan P. Dackiw MD, J. Nicolas Vauthey MD, Jeffrey E. Lee MD, Peter W. T. Pisters MD & Douglas B. Evans MD - Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
Kenneth R. Hess PhD - Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
Karen R. Cleary MD - Department of Gastrointestinal Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
Robert A. Wolff MD & James L. Abbruzzese MD - Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
Nora A. Janjan MD & Christopher H. Crane MD - Department of Surgical Oncology, UT M. D. Anderson Cancer Center, Box 444, 1515 Holcombe Blvd., Houston, TX, 77030
Douglas B. Evans MD
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- Tara M. Breslin MD
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Correspondence toDouglas B. Evans MD.
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Breslin, T.M., Hess, K.R., Harbison, D.B. et al. Neoadjuvant Chemoradiotherapy for Adenocarcinoma of the Pancreas: Treatment Variables and Survival Duration.Ann Surg Oncol 8, 123–132 (2001). https://doi.org/10.1007/s10434-001-0123-4
- Received: 26 July 2000
- Accepted: 20 November 2000
- Issue Date: March 2001
- DOI: https://doi.org/10.1007/s10434-001-0123-4