Downstaging of Pancreatic Carcinoma after Neoadjuvant Chemoradiation

Tinkl, Dominik; Grabenbauer, Gerhard G.; Golcher, Henriette; Meyer, Thomas; Papadopoulos, Thomas; Hohenberger, Werner; Sauer, Rolf; Brunner, Thomas

doi:10.1007/s00066-009-1977-9

Cited by 37 publications

(30 citation statements)

References 54 publications

(78 reference statements)

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“…We found that patients with pCR had better disease-specific survival than those with either post-treatment stage I or stage IIA disease. Our data is consistent with the previous findings from other carcinoma sites that pCR is associated with better prognosis [24][25][26][27][28][29]. Given the rarity and the limited number of patients with PDA who received neoadjvant CRT had pCR in pancreatectomy reported in this study, future collaborative studies of a larger patient population is needed to confirm the prognostic values of pCR in patients with PDA.…”

Section: Discussionsupporting

confidence: 92%

“…Another study from Germany [24] reported pCR in three of 38 patients (7.9%) with locally advanced PDA who received neoadjuvant chemoradiation. In our study, we found only 11 patients (2.5%) with pCR in a large consecutive cohort of 442 patients with PDA who completed neoadjuvant chemoradiation and subsequently underwent pancreatectomy at our institution from 1995 to 2010.…”

Section: Discussionmentioning

confidence: 96%

“…The extent of residual invasive adenocarcinoma in post-therapy specimens has been shown to correlate with the prognosis in patients with several types of carcinomas, including PDA, esophageal cancer, and rectal cancer [24][25][26][27][28][29]. In our previous study of 240 patients with PDA who received neoadjuvant CRT and pancreaticoduodenectomy, we showed that posttherapy tumor stage (ypT), lymph node status (ypN), and the post therapy AJCC pathologic stage were independent prognostic factors of both disease-free and overall survivals in this group of patients [30].…”

Section: Discussionmentioning

confidence: 99%

“…In other tumor sites, patients who achieved pCR after neoadjuvant therapy have better prognosis. Patients with pCR in rectal specimens who received neoadjuvant chemoradiation have better disease-free and overall survival than patients with residual rectal adenocarcinoma [24][25][26][27][28][29]. Similarly, patients with pCR in esophagectomy specimens after neoadjuvant therapy also had better prognosis than those with residual disease [12,14].…”

Section: Discussionmentioning

confidence: 99%

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Pathologic complete response to neoadjuvant therapy in patients with pancreatic ductal adenocarcinoma is associated with better prognosis

Wang¹,

Zhao²

2012

Annals of Diagnostic Pathology

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In patients with pancreatic ductal adenocarcinoma (PDA) who received neoadjuvant therapy and pancreatectomy, pathologic complete response (pCR) is rarely observed and the prognostic significance of pCR is not clear. In this study, we reported 11 patients with pCR (2.5%) from 442 patients with PDA who received neoadjuvant treatment and pancreatectomy from 1995 to 2010. There were 6 men and 5 women with median age of 61 years. Four patients had either synchronous or prior history of extra-pancreatic cancer. Five patients received neoadjuvant chemotherapy followed by chemoradiation, and 6 received chemoradiation alone. Ten patients had pancreaticoduodenectomy and one had distal pancreatectomy. Scar and chronic pancreatitis consistent with therapy effect were present in all cases (100%). Pancreatic intraepithelial neoplasia 3 (Pan IN3)/carcinoma in situ was present in 5 cases, PanIN1 and PanIN2 in 5 cases. However, no residual invasive carcinoma or lymph node metastasis was identified in all cases. Follow-up information was available in 10 patients. Follow-up time ranges from 6 to 194 months (median, 63 months). During follow-up, three patients died of other causes and one developed a second primary PDA in the tail of pancreas at 84 months after initial pancreaticoduodenectomy and died at 105 months after the initial diagnosis of PDA. The other 6 patients were alive with no evidence of disease. Patients with pCR had better survival than those who had post-therapy stage I or IIA

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pathologic complete response to neoadjuvant therapy in patients with pancreatic ductal adenocarcinoma is associated with better prognosis

Wang¹,

Zhao²

2012

Annals of Diagnostic Pathology

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“…In selected patients, neoadjuvant treatment can result in downstaging of pancreatic tumors and nodal spread [32] and adjuvant chemoradiotherapy should be considered after irradical resections [20]. However, previous randomized studies have reported significantly higher rates of hematologic and gastrointestinal toxicity with chemoradiotherapy [8,10,27].…”

Section: Introductionmentioning

confidence: 99%

Volumetric Modulated Arc Therapy for Advanced Pancreatic Cancer

et al. 2010

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Background: Intensity-modulated radiotherapy (IMRT) allows for improved sparing of organs at risk (OARs) in advanced pancreatic cancer. A planning study evaluated if volumetric modulated arc therapy (RapidArc™ [RA]) could be used as an alternative to IMRT in such cases. Patients and Methods: In ten patients, five-field IMRT (5f-IMRT) plans with fixed gantry positions were compared to RA plans using similar constraints for planning target volume (PTV) and OARs. PTV coverage, conformity indices (CI), and OAR doses were compared. One patient was treated using RA and calculated dose distributions were measured in coronal planes in a solid-water phantom. Results: RA plans showed superior mean CI of 1.09 ± 0.02 (± 1 SD [standard deviation]) versus 1.20 ± 0.10 in 5f-IMRT (p = 0.003). Both techniques achieved similar sparing of the right kidney, but RA significantly reduced left kidney doses with V 15 of 7.2% ± 5.3% and 15.9% ± 11.1%, respectively; p = 0.02. RA modestly decreased mean doses to liver (13.8 vs. 15.1 Gy; p = 0.003), stomach (16.7 vs. 17.9 Gy; p = 0.017), small bowel (19.8 vs. 22.1 Gy; p < 0.001), and duodenum (38.8 vs. 41.9 Gy; p = 0.004). Film dosimetry revealed excellent agreement between calculated and measured dose distributions. The delivery time for RA was < 3 min. Conclusion: RA planning achieved superior CI for pancreatic tumors compared to 5f-IMRT, and modestly reduced OAR doses. Fast treatment delivery using RA may decrease the risk of intrafractional organ motion. Ergebnisse: RA-Pläne zeigten einen günstigeren CI von 1,09 ± 0,02 (± 1 SD [Standardabweichung]) gegenüber 1,20 ± 0,10 bei 5f-IMRT (p = 0,003). Mit beiden Techniken gelang eine zufriedenstellende Dosisreduktion der rechten Niere, mittels RA konnten jedoch die V 15 der linken Niere signifikant reduziert werden (7,2% ± 5,3% vs. 15,9% ± 11,1% bei IMRT; p = 0,02). Geringer zeigte sich die Reduktion der mittleren Dosis der Leber (13,8 vs. 15,1 Gy; p = 0,003), des Magens (16,7 vs. 17,9 Gy; p = 0,017), des Dünndarms (19,8 vs. 22,1 Gy; p < 0,001) und des Duodenums (38,8 vs. 41,9 Gy; p = 0,004). Filmdosimetrische Überprüfungen zeigten hervorragende Übereinstimmungen bezüglich kalkulierter und tatsächlicher Dosisverteilung. Die Gesamtbestrahlungszeit betrug < 3 min. Schlussfolgerung: Mittels RA-Planung lässt sich im Vergleich zur 5f-IMRT sowohl ein günstigerer CI als auch moderate Dosisreduktion in den OAR erreichen. Durch die rasche Dosisapplikation vermindert sich das Risiko intrafraktionärer Bewegung der OAR.Schlüsselwörter: Pankreaskarzinom · "Volumetric modulated arc therapy" · Intensitätsmodulierte Radiotherapie · Planungsstudie · Risikoorgane

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