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Medline ® Abstract for Reference 109

of 'Initial chemotherapy and radiation for nonmetastatic, locally advanced, unresectable and borderline resectable, exocrine pancreatic cancer'

A phase II single institutional experience with preoperative radiochemotherapy in pancreatic adenocarcinoma.
Moutardier V, Giovannini M, Lelong B, Monges G, Bardou VJ, Magnin V, Charaffe-Jauffret E, Houvenaeghel G, Delpero JR
Eur J Surg Oncol. 2002 Aug;28(5):531-9.
BACKGROUND: Resection of pancreatic adenocarcinoma has a limited impact on survival. We hypothesized that delivering preoperative radiochemotherapy (RTCT) might enhance local control of the cancer and improve survival.
METHODS: Nineteen patients with localized pancreatic cancer (14 head and 5 body) were treated during the past 4 years with an intramural protocol consisting of continuous infusion of fluorouracile (5-FU: 650 mg/m(2)/D1-D5 and D21-D25 and Cisplatin 80 mg/m(2)/bolus D2 and D22 with preoperative external beam radiotherapy (RT) (30Gy split course RT or 45 Gy standard fractionation RT).
RESULTS: Four patients did not have surgical resection: Three patients were noted to have liver metastases and 1 patient developed peritoneal carcinomatosis. The remaining 15 patients had potentially curative resection (12 Whipple procedure and 3 distal subtotal pancreatectomy). There was no postoperative death. Pathologic findings showed five major responses including 2 patients with complete pathologic response. The overall median survival for the 19 study patientswas 20 months. The median disease free and 2-year overall survival for the group with resection were 30 months and 52.3%.
CONCLUSIONS: Preoperative RTCT followed by resection is well-tolerated and safe for patients with localized pancreatic cancer. Major histological response occurred for 25% of patients. This approach could offer improvement in patient survival.
Institut Paoli-Calmettes, Marseille, France. moutardierv@marseille.fnclcc.fr