Preoperative chemoradiation for patients with pancreatic cancer: Toxicity of endobiliary stents

Purpose: A recent multicenter study of preoperative chemoradiation and panc reaticoduodenectomy for localized pancreatic adenocarcinoma suggested that biliary stent-related complications are frequent and severe and may prevent the delivery of all components of multimodality therapy in many patients. The present study was designed to evaluate the rates of hepatic toxicity an d biliary stent-related complications and to evaluate the impact of this mo rbidity on the delivery of preoperative chemoradiation for pancreatic cance r at a tertiary care cancer center. Patients and Methods: Preoperative chemoradiation was used in 154 patients with resectable pancreatic adenocarcinoma (142 patients, 92%) or other peri ampullary rumors (12 patients, 8%). patients were treated with preoperative fluorouracil (115 patients), paclitaxel (37 patients), or gemcitabine (two patients) plus concurrent rapid-fractionation (30 Gy; 123 patients) or sta ndard-fractionation (50.4 Oy; 31 patients) radiation therapy. The incidence s of hepatic toxicity and biliary stent-related complications were evaluate d during chemoradiation and the immediate 3- to 4-week postchemoradiation p reoperative period. Results: Nonoperative biliary decompression was performed in 101 (66%) of 1 54 patients (endobiliary stent placement in 77 patients and percutaneous tr anshepatic catheter placement in 24 patients). Stent-related complications (occlusion or migration) occurred in 15 patients. Inpatient hospitalization for antibiotics and stent exchange was necessary in seven of 15 patients ( median hospital stay, 3 days). No patient experienced uncontrolled biliary sepsis, hepatic abscess, or stent-related death. Conclusion: preoperative chemoradiation for pancreatic cancer is associated with low rates of hepatic toxicity and biliary stent-related complications . The need for biliary decompression is not a clinically significant concer n in the delivery of preoperative therapy to patients with localized pancre atic cancer. (C) 2000 by American Society of Clinical Oncology.