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Preoperative gemcitabine and cisplatin followed by gemcitabine-based chemoradiation for resectable adenocarcinoma of the pancreatic head.

Publication ,  Journal Article
Varadhachary, GR; Wolff, RA; Crane, CH; Sun, CC; Lee, JE; Pisters, PWT; Vauthey, J-N; Abdalla, E; Wang, H; Staerkel, GA; Lee, JH; Ross, WA ...
Published in: J Clin Oncol
July 20, 2008

PURPOSE: We conducted a phase II trial of preoperative gemcitabine and cisplatin chemotherapy in addition to chemoradiation (Gem-Cis-XRT) and pancreaticoduodenectomy (PD) for patients with stage I/II pancreatic adenocarcinoma. PATIENTS AND METHODS: Chemotherapy consisted of gemcitabine (750 mg/m(2)) and cisplatin (30 mg/m(2)) given every 2 weeks for four doses. Chemoradiation consisted of four weekly infusions of gemcitabine (400 mg/m(2)) combined with radiation therapy (30 Gy in 10 fractions administered over 2 weeks) delivered 5 days per week. Patients underwent restaging 4 to 6 weeks after completion of chemoradiation and, in the absence of disease progression, were taken to surgery. RESULTS: The study enrolled 90 patients; 79 patients (88%) completed chemo-chemoradiation. Sixty-two (78%) of 79 patients were taken to surgery and 52 (66%) of 79 underwent PD. The median overall survival of all 90 patients was 17.4 months. Median survival for the 79 patients who completed chemo-chemoradiation was 18.7 months, with a median survival of 31 months for the 52 patients who underwent PD and 10.5 months for the 27 patients who did not undergo surgical resection of their primary tumor (P < .001). CONCLUSION: Preoperative Gem-Cis-XRT did not improve survival beyond that achieved with preoperative gemcitabine-based chemoradiation (Gem-XRT) alone. The longer preoperative interval required more durable biliary decompression (metal stents) but was not associated with local tumor progression. The gemcitabine-based chemoradiation platform is a reasonable foundation on which to build future phase II multimodality trials for stage I/II pancreatic cancer incorporating emerging systemic therapies.

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Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

July 20, 2008

Volume

26

Issue

21

Start / End Page

3487 / 3495

Location

United States

Related Subject Headings

  • Radiotherapy
  • Preoperative Care
  • Pancreaticoduodenectomy
  • Pancreatic Neoplasms
  • Oncology & Carcinogenesis
  • Neoadjuvant Therapy
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Humans
 

Citation

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Varadhachary, G. R., Wolff, R. A., Crane, C. H., Sun, C. C., Lee, J. E., Pisters, P. W. T., … Evans, D. B. (2008). Preoperative gemcitabine and cisplatin followed by gemcitabine-based chemoradiation for resectable adenocarcinoma of the pancreatic head. J Clin Oncol, 26(21), 3487–3495. https://doi.org/10.1200/JCO.2007.15.8642
Varadhachary, Gauri R., Robert A. Wolff, Christopher H. Crane, Charlotte C. Sun, Jeffrey E. Lee, Peter W. T. Pisters, Jean-Nicolas Vauthey, et al. “Preoperative gemcitabine and cisplatin followed by gemcitabine-based chemoradiation for resectable adenocarcinoma of the pancreatic head.J Clin Oncol 26, no. 21 (July 20, 2008): 3487–95. https://doi.org/10.1200/JCO.2007.15.8642.
Varadhachary GR, Wolff RA, Crane CH, Sun CC, Lee JE, Pisters PWT, et al. Preoperative gemcitabine and cisplatin followed by gemcitabine-based chemoradiation for resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008 Jul 20;26(21):3487–95.
Varadhachary, Gauri R., et al. “Preoperative gemcitabine and cisplatin followed by gemcitabine-based chemoradiation for resectable adenocarcinoma of the pancreatic head.J Clin Oncol, vol. 26, no. 21, July 2008, pp. 3487–95. Pubmed, doi:10.1200/JCO.2007.15.8642.
Varadhachary GR, Wolff RA, Crane CH, Sun CC, Lee JE, Pisters PWT, Vauthey J-N, Abdalla E, Wang H, Staerkel GA, Lee JH, Ross WA, Tamm EP, Bhosale PR, Krishnan S, Das P, Ho L, Xiong H, Abbruzzese JL, Evans DB. Preoperative gemcitabine and cisplatin followed by gemcitabine-based chemoradiation for resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008 Jul 20;26(21):3487–3495.

Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

July 20, 2008

Volume

26

Issue

21

Start / End Page

3487 / 3495

Location

United States

Related Subject Headings

  • Radiotherapy
  • Preoperative Care
  • Pancreaticoduodenectomy
  • Pancreatic Neoplasms
  • Oncology & Carcinogenesis
  • Neoadjuvant Therapy
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Humans