Preoperative Gemcitabine-Based Chemoradiation for Patients With Resectable Adenocarcinoma of the Pancreatic Head

Abstract

Preoperative gemcitabine-based chemoradiation followed by restaging and evaluation for surgery separated the study population into two different subsets: patients likely to benefit from PD (n = 64) and those in whom surgery would be unlikely to provide clinical benefit (n = 22). Furthermore, the encouraging overall survival observed in this large trial supports the continued investigation of gemcitabine-based preoperative therapy in resectable pancreatic cancer.

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

“…For the patient who had a prior history of breast cancer, the diagnosis of PDA on pancreatic FNA was based on the different tumor morphology, no other site of breast cancer metastasis at the time of pancreatic FNA, and increase serum level of carbohydrate antigen 19.9 (76 U/ ml). Among the 11 patients, five patients received systemic chemotherapy with gemcitabine and cisplatin followed by gemcitabine-based chemoradiation (Gem-Cis-XRT) as reported by Varadhachary, G.R., et al [8]; three patients received gemcitabine-based chemoradiation protocol as reported by Evans D. B. et al [7] and the remaining three patients received 5-fluorouracil-based chemoradiation [15] (Table 1).…”

“…In a phase II trial of 86 enrolled patients who received neoadjuvant gemcitabine-based chemoradiation, two patients were reported to have pCR in their subsequent pancreatectomy specimens [7]. Another study from Germany [24] reported pCR in three of 38 patients (7.9%) with locally advanced PDA who received neoadjuvant chemoradiation.…”

“…Neoadjuvant chemoradiation therapy (CRT) has been used as an alternative to "surgery-first" approach in patients with potentially resectable disease due to its potential to reduce in tumor volume, to treat micrometastasis, and to increase the likelihood of a complete resection, especially in borderline resectable cases. In a phase II trial of 86 enrolled patients who received neoadjuvant intravenous infusion of gemcitabine (400 mg/m 2 /weekly, over 7 weeks) plus external beam of radiation therapy (EBRT) therapy (30 Gy in 10 fractions, 3 Gy/day, over 2 weeks), Evans et al reported a median overall survival (OS) of 34 months in 64 of the 86 enrolled patients who underwent pancreaticoduodenectomy and a median overall survival of 22.7 months in all 86 patients with a 27% 5-year survival rate [7]. Fifty-eight percent of patients in this gemcitabine-based chemoradiation (GEM-XRT) trial showed partial pathologic response and two patients had pathologic complete response (pCR).…”

Influence of cholangitis after preoperative endoscopic biliary drainage on postoperative pancreatic fistula in patients with middle and lower malignant biliary strictures

“…27,28 Increasing numbers of patients will probably receive preoperative chemotherapy in the future. Therefore, methods that effectively prevent obstruction in the long term are needed.…”

Ep-CAM is a significant prognostic factor in pancreatic cancer patients by suppressing cell activity

“…The prognosis of patients after complete resection is poor, and more than 50% of patients develop tumor recurrence at distant or locoregional sites, with an estimated 5-year survival of only 20% (Kayahara et al, 1993;Nitecki et al, 1995;Staley et al, 1996;Sener et al, 1999;Li et al, 2004). The addition of chemotherapy and/or radiotherapy to surgical resection is important (Rothenberg et al, 1996;Oettle et al, 2007;Evans et al, 2008), however, the clinical response rate remains still unsatisfactory (Burris et al, 1997).…”