Carcinoma of the pancreas: Review of MGH experience from 1963 to 1973—Analysis of surgical failure and implications for radiation therapy

Abstract

A retrospective study was done of all patients who were seen for definitive treatment of adenocarcinoma of the pancreas at the Massachusetts General Hospital from 1963 to 1973. There were a total of 145 patients. Thirty-one patients were treated with radical surgery, with a 16% operative mortality, a 5-year crude survival rate of 15%, and a local recurrence rate of 50%. Sixty-two patients were treated with biopsy alone, with no 5-year survivors. In addition, there were 35 patients who did not have a radical surgical procedure performed only because of the extent of the local disease. It is proposed that postoperative irradiation may reduce the incidence of local failure after radical surgery, and that preoperative radiation therapy or radiation therapy alone would be an appropriate treatment of those patients in whom the local extent of disease is initially too far advanced to perform radical surgery.

Antiangiogenic versus cytotoxic therapeutic approaches in a mouse model of pancreatic cancer: An experimental study with a multitarget tyrosine kinase inhibitor (sunitinib), gemcitabine and radiotherapy

“…Complete resection in an early stage is the only option for cure. Despite potentially curative resection for pancreatic adenocarcinoma, local relapse (liver, intraabdominal) occurs in 50-85% of patients and results in a 5-year survival of <20% (2)(3)(4)(5)(6)(7). The frequency and pattern of recurrence make postoperative chemotherapy and/or radiation an important consideration.…”

Chemoradiation in Pancreatic Adenocarcinoma: A Literature Review

“…The relatively high rate of both locoregional and distant recurrence following surgery for pancreatic cancer makes a strong case for effective adjuvant therapy [40,41]. RCTs of CRT are limited, and the available data are boosted by some phase II and single-institution studies.…”

The role of adjuvant chemoradiation in the treatment of pancreatic cancer

“…Even patients who receive surgery with curative intent have poor outcomes. Five-year overall survival rates after pancreaticoduodenectomy are below 20 %, a number which has not substantially changed with time [4][5][6]. Analysis of failure patterns in patients after surgery indicates that 50-73 % of patients experience a local-regional recurrence [4,7], which provides a rationale for adjuvant localregional treatment.…”

“…Five-year overall survival rates after pancreaticoduodenectomy are below 20 %, a number which has not substantially changed with time [4][5][6]. Analysis of failure patterns in patients after surgery indicates that 50-73 % of patients experience a local-regional recurrence [4,7], which provides a rationale for adjuvant localregional treatment. However, the majority recur distantly, either concurrently with local recurrence or as a first site of failure, indicating that the mortality of this disease is largely caused by distant spread of disease rather than locally recurrent disease [8], suggesting that treatment that solely focuses on local control will have little survival benefit.…”