Second Chance for Unresectable Pancreatic Cancer

Laurie Barclay, MD

March 11, 2003

March 11, 2003 — Surgical resection may be efficacious after chemoradiotherapy in patients with unresectable pancreatic cancer, according to the results of a prospective trial reported in the February issue of the American Journal of Clinical Oncology.

"Simultaneous chemoradiation is used in unresectable pancreatic cancer for palliation," write Javier Aristu, MD, from the University of Navarre in Pamplona, Spain, and colleagues. "It is not known if the use of adjuvant surgery will benefit this group of patients."

From November 1991 to September 1998, 47 patients with unresectable pancreatic cancer received simultaneous preoperative radiation therapy (45 Gy) and chemotherapy with cisplatin and 5-fluorouracil with or without paclitaxel; cisplatin and protracted infusion of 5-fluorouracil; or docetaxel and gemcitabine. When this regimen was completed, 23 unresectable tumors (47%) received 10 to 12 Gy additional intraoperative or external radiation therapy. After chemoradiation, two patients died, one of pneumonia and one of gastrointestinal bleeding.

After preoperative treatment, 12 patients (26%) were considered to have clinically resectable tumors, and nine (19% of the total number of patients) had Whipple pancreatoduodenectomy one month after completion of radiation. Two of the surgically treated patients had a complete pathologic response, and two others died in the postoperative period. Distant metastases occurred in 57% and local recurrence in 22%. Three-year survival rate was 0% (median survival, 10 months) for patients with unresectable tumors and 48% (median survival, 23 months) for patients with resectable tumors ( P = .0004).

"The combination of different protocols of preoperative radiotherapy and chemotherapy in patients with unresectable pancreatic cancer is feasible with acceptable toxicity. A prospective randomized study is needed to identify subsets of patients who may benefit from surgical resection after preoperative chemoradiotherapy," the authors write. "Long-term survivors were observed in the group of resected tumors. More effective chemotherapy regimens are needed because the majority of the patients died of metastatic disease."

Am J Clin Oncol. 2003;26:30-36

Reviewed by Gary D. Vogin, MD

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