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Neoadjuvant chemoradiation for localized adenocarcinoma of the pancreas.

Publication ,  Journal Article
White, RR; Hurwitz, HI; Morse, MA; Lee, C; Anscher, MS; Paulson, EK; Gottfried, MR; Baillie, J; Branch, MS; Jowell, PS; McGrath, KM; Clary, BM ...
Published in: Ann Surg Oncol
December 2001

BACKGROUND: The use of neoadjuvant (preoperative) chemoradiotherapy (CRT) for pancreatic cancer has been advocated for its potential ability to optimize patient selection for surgical resection and to downstage locally advanced tumors. This article reports our experience with neoadjuvant CRT for localized pancreatic cancer. METHODS: Since 1995, 111 patients with radiographically localized, pathologically confirmed pancreatic adenocarcinoma have received neoadjuvant external beam radiation therapy (EBRT; median, 4500 cGy) with 5-flourouracil-based chemotherapy. Tumors were defined as potentially resectable (PR, n = 53) in the absence of arterial involvement and venous occlusion and locally advanced (LA, n = 58) with arterial involvement or venous occlusion by CT. RESULTS: Five patients (4.5%) were not restaged due to death (n = 3) or intolerance of therapy (n = 2). Twenty-one patients (19%) manifested distant metastatic disease on restaging CT. Twenty-eight patients with initially PR tumors (53%) and 11 patients with initially LA tumors (19%) were resected after CRT. Histologic examination revealed significant fibrosis in all resected specimens and two complete responses. Surgical margins were negative in 72%, and lymph nodes were negative in 70% of resected patients. Median survival in resected patients has not been reached at a median follow-up of 16 months. CONCLUSIONS: Neoadjuvant CRT provided an opportunity for patients with occult metastatic disease to avoid the morbidity of resection and resulted in tumor downstaging in a minority of patients with LA tumors. Survival after neoadjuvant CRT and resection appears to be at least comparable to survival after resection and adjuvant (postoperative) CRT.

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Published In

Ann Surg Oncol

DOI

ISSN

1068-9265

Publication Date

December 2001

Volume

8

Issue

10

Start / End Page

758 / 765

Location

United States

Related Subject Headings

  • Survival Rate
  • Pancreatic Neoplasms
  • Pancreatectomy
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Humans
  • Fluorouracil
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
White, R. R., Hurwitz, H. I., Morse, M. A., Lee, C., Anscher, M. S., Paulson, E. K., … Tyler, D. S. (2001). Neoadjuvant chemoradiation for localized adenocarcinoma of the pancreas. Ann Surg Oncol, 8(10), 758–765. https://doi.org/10.1007/s10434-001-0758-1
White, R. R., H. I. Hurwitz, M. A. Morse, C. Lee, M. S. Anscher, E. K. Paulson, M. R. Gottfried, et al. “Neoadjuvant chemoradiation for localized adenocarcinoma of the pancreas.Ann Surg Oncol 8, no. 10 (December 2001): 758–65. https://doi.org/10.1007/s10434-001-0758-1.
White RR, Hurwitz HI, Morse MA, Lee C, Anscher MS, Paulson EK, et al. Neoadjuvant chemoradiation for localized adenocarcinoma of the pancreas. Ann Surg Oncol. 2001 Dec;8(10):758–65.
White, R. R., et al. “Neoadjuvant chemoradiation for localized adenocarcinoma of the pancreas.Ann Surg Oncol, vol. 8, no. 10, Dec. 2001, pp. 758–65. Pubmed, doi:10.1007/s10434-001-0758-1.
White RR, Hurwitz HI, Morse MA, Lee C, Anscher MS, Paulson EK, Gottfried MR, Baillie J, Branch MS, Jowell PS, McGrath KM, Clary BM, Pappas TN, Tyler DS. Neoadjuvant chemoradiation for localized adenocarcinoma of the pancreas. Ann Surg Oncol. 2001 Dec;8(10):758–765.
Journal cover image

Published In

Ann Surg Oncol

DOI

ISSN

1068-9265

Publication Date

December 2001

Volume

8

Issue

10

Start / End Page

758 / 765

Location

United States

Related Subject Headings

  • Survival Rate
  • Pancreatic Neoplasms
  • Pancreatectomy
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Humans
  • Fluorouracil
  • Female