PMID- 9060530
OWN - NLM
STAT- MEDLINE
DCOM- 19970331
LR  - 20220331
IS  - 0732-183X (Print)
IS  - 0732-183X (Linking)
VI  - 15
IP  - 3
DP  - 1997 Mar
TI  - Preoperative and postoperative chemoradiation strategies in patients treated with 
      pancreaticoduodenectomy for adenocarcinoma of the pancreas.
PG  - 928-37
AB  - PURPOSE: The effects of preoperative versus postoperative fluorouracil 
      (5-FU)-based chemotherapy and irradiation on treatment toxicity, duration of 
      treatment, tumor recurrence, and survival were compared in patients who underwent 
      potentially curative therapy for adenocarcinoma of the pancreatic head during a 
      5-year period. METHODS: From July 1990 to July 1995, 142 patients with localized 
      adenocarcinoma of the pancreatic head deemed resectable on the basis of 
      radiographic images were treated with curative intent using a multimodality 
      approach involving either preoperative or postoperative chemoradiation. Patients 
      with biopsy confirmation of adenocarcinoma and a low-density mass in the 
      pancreatic head identified by computed tomography (CT) received preoperative 
      chemoradiation. Patients without a mass on CT or in whom the preoperative biopsy 
      was negative underwent pancreaticoduodenectomy with planned postoperative 
      chemoradiation. Protocol-based preoperative chemoradiation consisted of 
      external-beam irradiation at a dose of 50.4 Gy (standard fractionation; 1.8 Gy/d, 
      5 d/wk) or 30 Gy (rapid fractionation; 3 Gy/d, 5 d/wk) combined with continuous 
      infusion 5-FU (300 mg/m2/d, 5 d/wk). Postoperative chemoradiation combined 50.4 
      Gy of external-beam irradiation (standard fractionation) with continuous-infusion 
      5-FU. RESULTS: No patient who received preoperative chemoradiation experienced a 
      delay in surgery because of chemoradiation toxicity, but six of 25 eligible 
      patients (24%) did not receive postoperative chemoradiation because of delayed 
      recovery after pancreaticoduodenectomy. No significant differences in toxicities 
      from chemoradiation were observed between groups. Patients treated with 
      rapid-fractionation preoperative chemoradiation had a significantly (P < .01) 
      shorter duration of treatment (median, 62.5 days) compared with patients who 
      received postoperative chemoradiation (median, 98.5 days) or 
      standard-fractionation preoperative chemoradiation (median, 91.0 days). At a 
      median followup of 19 months, no significant differences in survival were 
      observed between treatment groups. No patient who received preoperative 
      chemoradiation and pancreaticoduodenectomy experienced a local recurrence; 
      peritoneal (regional) recurrence occurred in 10% of these patients. Local or 
      regional recurrence occurred in 21% of patients who received 
      pancreaticoduodenectomy and postoperative chemoradiation. CONCLUSION: Delivery of 
      preoperative and postoperative chemoradiation in patients who underwent 
      potentially curative pancreaticoduodenectomy for adenocarcinoma of the pancreatic 
      head resulted in similar treatment toxicity, patterns of tumor recurrence, and 
      survival. Rapid-fractionation preoperative chemoradiation ensured the delivery of 
      all components of therapy to all eligible patients with a significantly shorter 
      duration of treatment than with standard-fractionation chemoradiation given 
      either before or after pancreaticoduodenectomy. Prolonged recovery after 
      pancreaticoduodenectomy prevents the delivery of postoperative adjuvant 
      chemoradiation in up to one fourth of eligible patients.
FAU - Spitz, F R
AU  - Spitz FR
AD  - Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer 
      Center, Houston 77030, USA.
FAU - Abbruzzese, J L
AU  - Abbruzzese JL
FAU - Lee, J E
AU  - Lee JE
FAU - Pisters, P W
AU  - Pisters PW
FAU - Lowy, A M
AU  - Lowy AM
FAU - Fenoglio, C J
AU  - Fenoglio CJ
FAU - Cleary, K R
AU  - Cleary KR
FAU - Janjan, N A
AU  - Janjan NA
FAU - Goswitz, M S
AU  - Goswitz MS
FAU - Rich, T A
AU  - Rich TA
FAU - Evans, D B
AU  - Evans DB
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - J Clin Oncol
JT  - Journal of clinical oncology : official journal of the American Society of 
      Clinical Oncology
JID - 8309333
SB  - IM
CIN - J Clin Oncol. 1997 Oct;15(10):3291-3. PMID: 9336369
MH  - Adenocarcinoma/*drug therapy/pathology/*radiotherapy/surgery
MH  - Clinical Protocols
MH  - Combined Modality Therapy
MH  - Follow-Up Studies
MH  - Humans
MH  - Pancreatic Neoplasms/*drug therapy/pathology/*radiotherapy/surgery
MH  - *Pancreaticoduodenectomy
MH  - Prospective Studies
MH  - Survival Analysis
RF  - 44
EDAT- 1997/03/01 00:00
MHDA- 1997/03/01 00:01
CRDT- 1997/03/01 00:00
PHST- 1997/03/01 00:00 [pubmed]
PHST- 1997/03/01 00:01 [medline]
PHST- 1997/03/01 00:00 [entrez]
AID - 10.1200/JCO.1997.15.3.928 [doi]
PST - ppublish
SO  - J Clin Oncol. 1997 Mar;15(3):928-37. doi: 10.1200/JCO.1997.15.3.928.