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Surgical resection in unresectable pancreatic cancer

Unresectable pancreatic adenocarcinoma may be downstaged by chemoradiotherapy to allow for surgical resection, with a median survival comparable to resection for initially resectable pancreatic cancer, finds September's Journal of the American College of Surgeons.

News image

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The use of chemoradiotherapy for pancreatic cancer has been advocated for its potential ability to downstage locally advanced tumors.

Dr Masson and colleagues from France report an experience with chemoradiotherapy for patients with unresectable, locally advanced pancreatic cancer.

The patients had radiographically unresectable, pathologically confirmed pancreatic adenocarcinoma.

The researchers reported that since 1998, 61 of these patients have received standard fractionation radiation therapy with chemotherapy.

Chemotherapy included a continuous infusion of fluorouracil and cisplatin.

The team reported that patients with tumor response at restaging CT scan underwent surgical exploration to determine whether the tumor was resectable.

The researchers found that 62% of restaged patients demonstrated a disease progression.

38% had an objective response with persistence of arterial encasement
Journal of the American College of Surgeons

The research team noted that 38% had an objective response, with, in all cases, persistence of arterial encasement.

The researchers reported that 23 patients underwent exploratory operations after chemoradiotherapy, and 13 underwent standard Whipple resection.

Of 56% of patients who had exploratory operation, 21% underwent surgical resection.

The team observed that with a median follow-up of 27 months, median survival for the resected patients was 28 months.

Median survival was 11 months in 38 patients of the nonresponder group and 20 months of 10 patients in the group who received a palliative procedure.

Dr Masson's team concludes, “Locally advanced, unresectable pancreatic adenocarcinoma may be downstaged by chemoradiotherapy to allow for surgical resection.”

“Patients whose cancer becomes resectable have a median survival at least comparable with survival after resection for initially resectable pancreatic adenocarcinoma.”

J Am Coll Surg 2005: 201(3): 359-65
30 August 2005

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