Preoperative radiochemotherapy in pancreatic carcinoma: Preliminary results

Aims and background: The prognosis of pancreatic cancer remains poor. Surge ry, when feasible, is rarely curative. Radiation therapy (RT) and concomita nt 5-fluorouracil (5-FU) have been shown to improve survival in locally adv anced pancreatic cancer. In an attempt to improve resectability and disease control, we used preoperative chemoradiation in a combined modality therap y protocol. The purpose of this study was to evaluate our initial results i n terms of acute toxicity and response. Methods: From October 1995 to May 1 998, 20 patients (11 males, 9 females; mean age, 60.1 years; median follow- up, 28 months) with unresectable (12 patients) or resectable (8 patients) n onmetastatic pancreatic tumors, received external beam radiation (39.6 Gy) plus 5-FU (96 hours continuous infusion, days 1-4 at 1000 mg/m(2)/day). Aft er 4 weeks, patients were evaluated for surgical resection. in resected pat ients, electron-beam intraoperative radiation therapy (10 Gy) was given bef ore reconstruction. Thereafter, in resected patients, adjuvant chemotherapy was prescribed (6 courses: 5-FU, mitomycin C, adriamicine). Results: Durin g chemoradiation, no patients developed grade 3-4 acute toxicity Three out of twelve (25%) patients with unresectable tumors had tumor downstaging. No patients showed partial or complete responses. Four out of twenty patients (20%) had minimal tumor response. Three patients showed disease progressio n after chemoradiation (liver or peritoneal metastases). Nine patients unde rwent surgical resection and IORT, with 1 postoperative death. The median s urvival time for the 20 patients was 9.4 (18.5 and 8.3 months in resected a nd unresected patients, respectively). Conclusion: Our preliminary results suggest that preoperative 5-FU chemoradiation was well tolerated and may re sult in tumor downstaging but the response-rate is still tow. Based on the impact of surgical resection on survival, an improvement in local response rate is necessary.