CA-19-9 IS AN INDEX OF RESPONSE TO NEOADJUNCTIVE CHEMORADIATION THERAPY IN PANCREATIC-CANCER

PURPOSE: This Study examines the changes of serum levels of CA 19-9 in patients with pancreatic cancer following neoadjuvant irradiation and chemotherapy to define the potential role of this tumor marker in pre operative management of these patients, MATERIALS AND METHODS: Serum C A 19-9 levels were measured in 42 patients before receiving external b eam irradiation with concurrent 5-fluorouracil in preparation for lapa rotomy and Whipple procedure or intraoperative irradiation (IORT). The CA 19-9 levels were determined again after irradiation, and changes w ere correlated with findings of restaging computed tomography (CT) sca n and laparotomy, RESULTS: Following preoperative irradiation, 10 pati ents (24%) experienced an increase in CA 19-9 levels whereas 29 patien ts (69%) showed a decrease in CA 19-9, There was no change in the CA 1 9-9 levels of 3 patients (7%) after treatment, Of the 10 patients with increased CA 19-9 levels after irradiation, 9 (90%) had developed dis tant metastases or local tumor progression as determined by restaging CT scan or at laparotomy. In contrast, only 6 of 29 patients (21%) wit h declining CA 19-9 levels after irradiation demonstrated metastases o r local tumor progression on restaging CT scan or at laparotomy. The c orrelation of CA 19-9 increase or decrease with disease progression or control, respectively, was statistically significant (P = 0.009), CON CLUSIONS: Serum CA 19-9 levels may rise or fall during neoadjuvant the rapy, A rising CA 19-9 reliably indicates cancer progression while a f alling CA 19-9 connotes disease control in the majority of patients, I n developing strategies for application of neoadjuvant therapy for pan creatic cancer, monitoring of CA 19-9 appears most useful for the iden tification of patients who manifest progressive tumor growth and metas tasis in spite of this treatment.