Preoperative chemoradiation for marginally resectable adenocarcinoma of the pancreas

Only 10% to 20% of patients with pancreatic cancer are considered candidate s for curative resection at tile time of diagnosis. We postulated that preo perative chemoradiation therapy might promote turner regression, eradicate nodal metastases, and allow for definitive surgical resection in marginally resectable patients. Tile objective of this study was to evaluate the effe ct of a preoperative chemoradiation therapy regimen on tumor response , res ectability, and local control among patients with marginally resectable ade nocarcinoma of the pancreas and to report potential treatment-related toxic ity Patients with marginally resectable adenocarcinoma of tile pancreas (de fined as portal vein, superior mesenteric vein, or artery involvement) were eligible for this protocol. Patients received 50.4 to 56 Gy in 1.8 to 2.0 Gy/day fractions with concurrent protracted venous infusion of 5-fluorourac il (250 mg/m(2)/day). Reevaluation for surgical resection occurred 4 to 6 w eeks after therapy. Fifteen patients (9 men and 6 women) completed preopera tive chemoradiation without interruption. One patient required a reduction in the dosage of 5-fluorouracil because of stomatitis. Acute toxicity from chemoradiation consisted of grade 1 or 2 nausea, vomiting, diarrhea, stomat itis, palmar and plantar crythrodysesthesia, and hematologic suppression. C h 19-9 levels declined in all nine of the patients with elevated pretreatme nt levels. Nine of the 15 patient underwent a pancreaticoduodenectomy, and all had uninvolved surgical margins. Two of these patients had a complete p athologic response, and two had microscopic involvement of a single lymph n ode. With a median follow-up of 30 months, tile median survival for resecte d patients was 30 months, whereas in the unresected group median survival n as 8 months. Sh of the nine patients who underwent resection remain alive and disease free with follow-up of 30, 30, 34, 39, and 72 months, respectiv ely. Preoperative chemoradiation therapy is well tolerated. It may downstag e tumors, sterilize regional lymph nodes, and improve resectability in pati ents with marginally resectable pancreatic cancer. Greater patient accrual and longer follow-up are needed to more accurately assess its future role i n therapy.