Does neoadjuvant chemoradiation downstage locally advanced pancreatic cancer? Journal Article
| Authors: | Kim, H. J.; Czischke, K.; Brennan, M. F.; Conlon, K. C. |
| Article Title: | Does neoadjuvant chemoradiation downstage locally advanced pancreatic cancer? |
| Abstract: | Recent studies suggest that neoadjuvant chemoradiation can downstage locally advanced pancreatic tumors. There is limited evaluable data to support this approach. We review our experience with preoperative chemoradiation for surgically staged, locally advanced pancreatic cancer to determine whether patients are downstaged with multimodal therapy allowing for curative resection. A prospectively collected database from Memorial Sloan-Kettering Cancer Center was reviewed. Patients admitted between January 1993 and March 1999 with locally advanced pancreatic adenocarcinoma were identified (N = 163). Chemoradiation was administered to 87 (53.3%) of 163, and regimens varied from standard 5-fluorouracil/gemcitabine-based therapies to experimental protocols. Only three patients (3/87; 3.4%) had a sufficient clinical response on restaging to warrant reexploration. Of these, two thirds were unresectable on subsequent laparoscopy because of extensive vascular involvement or metastatic disease. Only one patient underwent a potentially curative resection, with a survival of 18 months despite negative margins and no nodal involvement. The overall median survival for all patients with locally advanced disease treated with chemoradiation was 11 months (6.5 months without multimodal therapy; P = 0.004). Although chemoradiation is associated with improved overall survival in locally advanced disease, it rarely leads to surgical "downstaging" allowing for potentially curative pancreatic resections. Novel multimodality approaches are required. © 2002 The Society for Surgery of the Alimentary Tract, Inc. |
| Keywords: | adult; cancer survival; controlled study; treatment outcome; aged; aged, 80 and over; middle aged; cancer surgery; survival rate; retrospective studies; major clinical study; clinical trial; mortality; review; cancer localization; cisplatin; fluorouracil; advanced cancer; antineoplastic agents; gemcitabine; adjuvant therapy; cancer radiotherapy; neoadjuvant therapy; pancreatic neoplasms; topotecan; cancer staging; antineoplastic agent; neoplasm staging; laparoscopy; adenocarcinoma; metastasis; controlled clinical trial; pathology; data base; retrospective study; survival time; adjuvant chemotherapy; pancreas tumor; pancreas adenocarcinoma; cancer registry; hospital admission; locally advanced; pancreatic cancer; chemoradiation; humans; prognosis; human; male; female; article; downstaging |
| Journal Title: | Journal of Gastrointestinal Surgery |
| Volume: | 6 |
| Issue: | 5 |
| ISSN: | 1091-255X |
| Publisher: | Springer |
| Date Published: | 2002-09-01 |
| Start Page: | 763 |
| End Page: | 769 |
| Language: | English |
| DOI: | 10.1016/s1091-255x(02)00017-3 |
| PUBMED: | 12399067 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Presented at the 41st Annual Meeting of The Society for Surgery of the Alimentary Tract; 2000 May 21-24; San Diego, CA -- Export Date: 14 November 2014 -- Source: Scopus |
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