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Significance of histological response to preoperative chemoradiotherapy for pancreatic cancer.

Publication ,  Journal Article
White, RR; Xie, HB; Gottfried, MR; Czito, BG; Hurwitz, HI; Morse, MA; Blobe, GC; Paulson, EK; Baillie, J; Branch, MS; Jowell, PS; Clary, BM ...
Published in: Ann Surg Oncol
March 2005

BACKGROUND: Neoadjuvant (preoperative) chemoradiotherapy (CRT) for pancreatic cancer offers theoretical advantages over the standard approach of surgery followed by adjuvant CRT. We hypothesized that histological responses to CRT would be significant prognostic factors in patients undergoing neoadjuvant CRT followed by resection. METHODS: Since 1994, 193 patients with biopsy-proven pancreatic adenocarcinoma have completed neoadjuvant CRT, and 70 patients have undergone resection. Specimens were retrospectively examined by an individual pathologist for histological responses (tumor necrosis, tumor fibrosis, and residual tumor load) and immunohistochemical staining for p53 and epidermal growth factor receptor. Factors influencing overall survival were analyzed with the Kaplan-Meier (univariate) and Cox proportional hazards (multivariate) methods. RESULTS: The estimated overall survival (median +/- SE) in the entire group of patients undergoing resection was 23 +/- 4.2 months, with an estimated 3-year survival of 37% +/- 6.6% and a median follow-up of 28 months. Complete histological responses occurred in 6% of patients. Overexpression of p53 was more common in patients with large residual tumor loads. Tumor necrosis was an independent negative prognostic factor, as were positive lymph nodes, a large residual tumor load, and poor tumor differentiation. CONCLUSIONS: Histological response to neoadjuvant CRT--as measured by residual tumor load--may be useful as a surrogate marker for treatment efficacy. Characterization of the tumor cells that survive neoadjuvant CRT may help us to identify new or more appropriate targets for systemic therapy.

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Published In

Ann Surg Oncol

DOI

ISSN

1068-9265

Publication Date

March 2005

Volume

12

Issue

3

Start / End Page

214 / 221

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Analysis
  • Risk Factors
  • Retrospective Studies
  • Radiotherapy, Adjuvant
  • Proportional Hazards Models
  • Prognosis
  • Pancreatic Neoplasms
  • Oncology & Carcinogenesis
  • Neoplasm Staging
 

Citation

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White, R. R., Xie, H. B., Gottfried, M. R., Czito, B. G., Hurwitz, H. I., Morse, M. A., … Tyler, D. S. (2005). Significance of histological response to preoperative chemoradiotherapy for pancreatic cancer. Ann Surg Oncol, 12(3), 214–221. https://doi.org/10.1245/ASO.2005.03.105
White, Rebekah R., H Bill Xie, Marcia R. Gottfried, Brian G. Czito, Herbert I. Hurwitz, Michael A. Morse, Gerald C. Blobe, et al. “Significance of histological response to preoperative chemoradiotherapy for pancreatic cancer.Ann Surg Oncol 12, no. 3 (March 2005): 214–21. https://doi.org/10.1245/ASO.2005.03.105.
White RR, Xie HB, Gottfried MR, Czito BG, Hurwitz HI, Morse MA, et al. Significance of histological response to preoperative chemoradiotherapy for pancreatic cancer. Ann Surg Oncol. 2005 Mar;12(3):214–21.
White, Rebekah R., et al. “Significance of histological response to preoperative chemoradiotherapy for pancreatic cancer.Ann Surg Oncol, vol. 12, no. 3, Mar. 2005, pp. 214–21. Pubmed, doi:10.1245/ASO.2005.03.105.
White RR, Xie HB, Gottfried MR, Czito BG, Hurwitz HI, Morse MA, Blobe GC, Paulson EK, Baillie J, Branch MS, Jowell PS, Clary BM, Pappas TN, Tyler DS. Significance of histological response to preoperative chemoradiotherapy for pancreatic cancer. Ann Surg Oncol. 2005 Mar;12(3):214–221.
Journal cover image

Published In

Ann Surg Oncol

DOI

ISSN

1068-9265

Publication Date

March 2005

Volume

12

Issue

3

Start / End Page

214 / 221

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Analysis
  • Risk Factors
  • Retrospective Studies
  • Radiotherapy, Adjuvant
  • Proportional Hazards Models
  • Prognosis
  • Pancreatic Neoplasms
  • Oncology & Carcinogenesis
  • Neoplasm Staging