A SINGLE INSTITUTIONAL EXPERIENCE WITH PREOPERATIVE CHEMORADIOTHERAPYFOR STAGE-I-III PANCREATIC ADENOCARCINOMA

In order to determine whether preresectional chemoradiotherapy (CTRT) would influence resectability, local control, and survival of patients with localized pancreatic adenocarcinoma, a 5 1/2-year prospective st udy of 39 patients treated with preoperative radiation therapy, 5-Fluo rouracil (5-FU), and Mitomycin C has been performed. Thirty patients h ad celiotomy after CTRT (1/39 died while receiving CTRT, one refused s urgery, and seven had extrapancreatic disease progression). Seventeen (57%) had resections (seven total, two distal subtotal, and eight Whip ple pancreaticoduodenectomies). All had clear margins of excision, and only one had any positive lymph nodes in the resected specimen. Eleve n patients with resection had Stage I cancers (5 T1b, 6 T2), five had Stage II, and one had a Stage III lesion. Previous bypass surgery, age , clinical response to CTRT, and tumor size had no influence on resect ability. Two patients died postoperatively (12%) early in the series. Three others suffered major morbidity (chylous ascites requiring perit oneovenous shunt, ARDS, and prolonged afferent loop obstruction leadin g to a fatal liver abscess 5 months after surgery). Two patients with resection are alive without recurrence at 48 months after tissue diagn osis, and six others are also alive without recurrence, after from 6 t o 23 months. In summary, resectability is probably enhanced and nodal metastases and resection margins are downstaged by preoperative CTRT. Demonstration of an improved survival benefit awaits further observati on and phase III trials.