Simultaneous chemoradiation is used in unresectable pancreatic cancer for palliation.
However, it is not known if the use of adjuvant surgery will benefit this group of patients.
In this study, researchers from Spain treated 47 patients with unresectable pancreatic cancer, using simultaneous preoperative radiation therapy (45 Gy) and chemotherapy between 1991 and 1998.
The chemotherapy followed 3 different protocols: cisplatin, 5-fluorouracil plus or minus paclitaxel; cisplatin, 5-fluorouracil (protracted infusion); and docetaxel and gemcitabine.
The team performed a Whipple pancreatoduodenectomy 1 month after the end of radiation, in patients selected for resection.
|12 patients were considered to have clinically resectable tumors after the preoperative treatment.|
|American Journal of Clinical Oncology|
Following preoperative treatment 23 patients with unresectable tumors received an additional dose (10 to 12 Gy) of radiotherapy.
The research team found that 12 patients were considered to have clinically resectable tumors after the preoperative treatment. Of these, 9 patients had surgery, and 2 had complete pathologic response.
However, after chemoradiation, 2 patients died of pneumonia and GI, and a further 2 patients died in the postoperative period.
Local recurrence was observed in 22% of the patients, and 57% had distant metastases.
The team found that 3-year survival rates for patients with unresectable and resectable tumors were 0% and 48%, respectively.
Dr Javier Aristu’s team concluded, “Preoperative treatment with chemotherapy and radiotherapy in patients with unresectable pancreatic cancer is feasible”.
“In some patients, the tumor can be resected, and in addition some cases of complete pathologic response were found.”
“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.”