PMID- 11309645
OWN - NLM
STAT- MEDLINE
DCOM- 20010816
LR  - 20240213
IS  - 1091-255X (Print)
IS  - 1091-255X (Linking)
VI  - 5
IP  - 1
DP  - 2001 Jan-Feb
TI  - Preoperative chemoradiation for marginally resectable adenocarcinoma of the 
      pancreas.
PG  - 27-35
AB  - Only 10% to 20% of patients with pancreatic cancer are considered candidates for 
      curative resection at the time of diagnosis. We postulated that preoperative 
      chemoradiation therapy might promote tumor regression, eradicate nodal 
      metastases, and allow for definitive surgical resection in marginally resectable 
      patients. The objective of this study was to evaluate the effect of a 
      preoperative chemoradiation therapy regimen on tumor response, resectability, and 
      local control among patients with marginally resectable adenocarcinoma of the 
      pancreas and to report potential treatment-related toxicity. Patients with 
      marginally resectable adenocarcinoma of the pancreas (defined 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-fluorouracil (250 mg/m2/day). Reevaluation for 
      surgical resection occurred 4 to 6 weeks after therapy. Fifteen patients (9 men 
      and 6 women) completed preoperative 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, stomatitis, palmar and plantar erythrodysesthesia, and 
      hematologic suppression. CA 19-9 levels declined in all nine of the patients with 
      elevated pretreatment levels. Nine of the 15 patients underwent a 
      pancreaticoduodenectomy, and all had uninvolved surgical margins. Two of these 
      patients had a complete pathologic response, and two had microscopic involvement 
      of a single lymph node. With a median follow-up of 30 months, the median survival 
      for resected patients was 30 months, whereas in the unresected group median 
      survival was 8 months. Six of the nine patients who underwent resection remain 
      alive and disease free with follow-up of 12, 30, 30, 34, 39, and 72 months, 
      respectively. Preoperative chemoradiation therapy is well tolerated. It may 
      downstage tumors, sterilize regional lymph nodes, and improve resectability in 
      patients with marginally resectable pancreatic cancer. Greater patient accrual 
      and longer follow-up are needed to more accurately assess its future role in 
      therapy.
FAU - Mehta, V K
AU  - Mehta VK
AD  - Department of Radiation Oncology, Stanford University Medical Center, Stanford, 
      CA 94305, USA. vmehta@leland.stanford.edu
FAU - Fisher, G
AU  - Fisher G
FAU - Ford, J A
AU  - Ford JA
FAU - Poen, J C
AU  - Poen JC
FAU - Vierra, M A
AU  - Vierra MA
FAU - Oberhelman, H
AU  - Oberhelman H
FAU - Niederhuber, J
AU  - Niederhuber J
FAU - Bastidas, J A
AU  - Bastidas JA
LA  - eng
PT  - Journal Article
PL  - Netherlands
TA  - J Gastrointest Surg
JT  - Journal of gastrointestinal surgery : official journal of the Society for Surgery 
      of the Alimentary Tract
JID - 9706084
RN  - 0 (Antimetabolites, Antineoplastic)
RN  - U3P01618RT (Fluorouracil)
SB  - IM
MH  - Adenocarcinoma/diagnosis/mortality/*surgery
MH  - Aged
MH  - Aged, 80 and over
MH  - Antimetabolites, Antineoplastic/*therapeutic use
MH  - Biopsy
MH  - Chemotherapy, Adjuvant
MH  - Diarrhea/chemically induced
MH  - Female
MH  - Fluorouracil/*therapeutic use
MH  - Follow-Up Studies
MH  - Hematologic Diseases/chemically induced
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Nausea/chemically induced
MH  - Neoplasm Staging
MH  - Pancreatic Neoplasms/diagnosis/mortality/*surgery
MH  - *Pancreaticoduodenectomy
MH  - Patient Selection
MH  - Preoperative Care/*methods
MH  - Radiotherapy Dosage
MH  - Radiotherapy, Adjuvant
MH  - Stomatitis/chemically induced
MH  - Survival Analysis
MH  - Tomography, X-Ray Computed
MH  - Treatment Outcome
MH  - Vomiting/chemically induced
EDAT- 2001/04/20 10:00
MHDA- 2001/08/17 10:01
CRDT- 2001/04/20 10:00
PHST- 2001/04/20 10:00 [pubmed]
PHST- 2001/08/17 10:01 [medline]
PHST- 2001/04/20 10:00 [entrez]
AID - S1091-255X(01)80010-X [pii]
AID - 10.1016/s1091-255x(01)80010-x [doi]
PST - ppublish
SO  - J Gastrointest Surg. 2001 Jan-Feb;5(1):27-35. doi: 10.1016/s1091-255x(01)80010-x.