Preoperative Chemoradiation in Locally Advanced Pancreatic Carcinoma: A Phase II Study

Abstract

Background: Effectiveness and feasibility of preoperative chemoradiation (CRT) in locally advanced adenocarcinoma of the pancreas are evaluated. Material and Methods: 29 eligible of 37 registered patients were treated. 3d-Conformal external radiotherapy was delivered with a 1.8-Gy single dose and a total dose of 50.4 Gy plus 5.4 Gy boost. Simultaneous chemotherapy consisted of 5-fluorouracil and mitomycin C. Results: Among 27 completely treated patients, 16 (59%) underwent surgery, 6 of them being irresectable intraoperatively. Ten patients (37%) had clear resection margins at Whipple’s procedure. Eleven patients were not considered for surgery (7 still irresectable at restaging, 3 distant metastases, 1 refusal of surgery). Toxicity was predominantly hematological (grade 3: 30%, grade 4: 7%); furthermore, there was nausea/vomiting (grade 3: 20%, grade 4: 0%). No patient died perioperatively. The tumor-related overall survival rate was better for resected patients than for nonresected patients (50% vs. 6%, 2-year survival, p = 0.07), median overall survival was 9 months (median follow-up, 28 months). Conclusions: Neoadjuvant CRT without significant acute toxicity produced a resectability rate of 37% (all R0), which should be confirmed by randomized phase III studies.

Radiotherapy in Pancreatic Cancer

“…This comprises stenting of the common bile duct, anti-emetic treatment, proton-pump inhibitor therapy, analgesia and parenteral feeding if necessary. Resectability should be re-evaluated 6-8 weeks after completion of CRT to exploit the possibility of a curative resection [7,8,53,58,60,61]. Curative resection (R0) can be performed in 15-25% of the patients.…”

Long-Term Outcome of Mitomycin C- and 5-FU-Based Primary Radiochemotherapy for Esophageal Cancer

“…Notably, in the initial radiochemotherapy trials that proved the superiority of radiochemotherapy over radiotherapy alone, mitomycin C (MMC) was used [13]. Although being a well-established radiosensitizer for the treatment of head and neck cancer [9,20], cancer of the anal canal [17], pancreatic carcinoma [7,37], vulvar and cervical cancer [5,27,38,39] the drug has not only lost acceptance in the treatment of esophageal cancer, but its effectiveness has been seriously called into question [19].…”

Mitomycin C in the Treatment of Gastrointestinal Tumours: Recent Data and Perspectives

“…On the other hand, the main toxicities in both treatment arms were comparable; only the incidence in neutropenia was increased in the MMC arm. Another interesting study published by Brunner et al [21] in the year 2000 investigated preoperative chemoradiation with 5-FU and MMC in locally advanced pancreatic carcinoma. In this study, 10 out of 27 completely treated patients (37%) achieved an R0 resection resulting in a 2-year survival rate of 50% for the resected patients in comparison to 6% for the non-resected patients.…”