L. Coia et al., PREOPERATIVE CHEMORADIATION FOR ADENOCARCINOMA OF THE PANCREAS AND DUODENUM, International journal of radiation oncology, biology, physics, 30(1), 1994, pp. 161-167
Citations number
27
Categorie Soggetti
Oncology,"Radiology,Nuclear Medicine & Medical Imaging
Purpose: This study was designed to evaluate the effects of preoperati
ve chemoradiation on resectability, response, local control, and survi
val in patients with local or local-regional involvement from carcinom
a of the pancreas or cancer of the duodenum and to assess the associat
ed toxicity of such treatment. Methods and Materials: This prospective
pilot study of preoperative chemoradiation was initiated in 1986 for
patients with clinical evidence of adenocarcinoma of the pancreas or d
uodenum without evidence of distant metastases. Radiation was given at
1.8 Gy per day to a total dose of 50.4 Gy. Two cycles of chemotherapy
were given concurrent with radiation. On days 2-5 and 29-32, 5-fluoro
uracil (1 gm/m(2)/24 h X 4 days) was given, while mitomycin-C (10 mg/m
(2)) was given on day 2 only. Surgical resection was 4-6 weeks followi
ng completion of chemoradiation. Thirty-one patients (17 male and 14 f
emale) were entered on the protocol with a median potential follow-up
of 4.5 years (range 6 months to 7.5 years). The median age was 64 year
s (range 32-73 years). Twenty-seven patients had pancreatic cancer (25
head, two body), while four patients had carcinoma arising from the d
uodenum. Twenty-one patients were initially judged to be unresectable
and ten potentially resectable prior to chemoradiation. Results: Twent
y-nine of 31 patients completed the entire course of radiation and bot
h cycles of chemotherapy. Acute toxicity from chemoradiation consisted
of nausea, vomiting, diarrhea, stomatitis, or hematologic suppression
which was moderate to severe (Grade 3 or 4) in seven patients (23%).
One patient died of sepsis following the first week of therapy. Sevent
een patients (55%) underwent curative resection with subtotal or total
pancreatectomy or Whipple resection (four duodenum, 13 pancreas) and
two (2/17) had pathologic nodal involvement, while (0/17) none had inv
olved margins. A complete pathologic response was seen in all four (4/
4) patients with duodenal cancer and in none (0/13) with pancreatic ca
ncer who underwent resection. The median postoperative hospitalization
stay was 22 days (range 4-144 days). Of 17 patients who underwent cur
ative resection, there were two postoperative mortalities (12%). Late
complications have included abscess, one; and nonmalignant ascites, fi
ve. Ten of the 31 patients are alive. For patients with pancreatic can
cer the median survival is 9 months, while survival at 1 year and 3 ye
ars are 36% and 19% overall and 60% and 43% at 1 and 3 years for those
undergoing resection. Six of the 27 patients (22%) with pancreatic ca
ncer are alive without recurrence. All four patients with duodenal can
cer are alive without recurrence (12 months, 23 months, 35 months, 90
months). Conclusion: Preoperative chemoradiation for cancer of the pan
creas and duodenal region was relatively well-tolerated and enhanced r
esectability and downstaging of nodal metastases were suggested. The 3
-year survival, particularly in patients who underwent resection, was
high. For these reasons the applicability of this treatment regimen fo
r pancreatic cancer is presently being studied in a group-wide multi-i
nstitutional Phase II trial. Chemoradiation for duodenal cancer has pr
oduced a complete pathologic response in all patients and survival has
been excellent, suggesting efficacy of this regimen for duodenal canc
er.