Preoperative irradiation in carcinoma of the pancreas

Pilepich, Miljenko V.; Miller, Harry H.

doi:10.1002/1097-0142(19801101)46:9<1945::aid-cncr2820460908>3.0.co;2-x

Cited by 136 publications

(51 citation statements)

References 11 publications

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“…Pilepich and Miller used preoperative radiotherapy with the result, that two of six patients who had Whipple's resection survived 5 years or longer. Clear conversion from an nonresectable to a resectable lesion could be documented in only one of six patients [59]. Ishikawa and co-workers [34] found out in a comparative case-control study, that preoperative irradiation downstages the tumour and decreases local recurrence rates and early death from local recurrence.…”

Section: Neoadjuvant Treatmentmentioning

confidence: 96%

Resection and radiochemotherapy of pancreatic cancer – the future?

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Formentini²,

Leder³

et al. 1998

Langenbecks Arch Chir

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Background: To improve the surgical outcome after resection of pancreatic adenocarcinomas, multimodal treatment concepts need to be applied and improved. The controversies among those being pro and contra adjuvant treatment need an up-to-date review of the indications and results achievable with various treatment modalities. Patients/Methods: The literature regarding the indications and results of adjuvant/neoadjuvant therapies in pancreatic cancer was reviewed to provide a solid base for current recommendations and future developments. The biology of the disease in the spontaneous course, after surgery and during/after various palliative and adjuvant/neoadjuvant treatment modalities was focussed on, to characterise the disease for an optimally targeted treatment in conjunction with surgical removal of the tumour. The results of systemic and regional chemotherapy and radiotherapy, either alone or in combination, before, during and after surgery were critically analysed with respect to the oncological possibilities and pitfalls of each treatment method. Results: In two randomised trials, one testing postoperative radiochemotherapy (GITSG), and one postoperative chemotherapy, the adjuvant treatment achieved a significant prolongation of the median survival time. The 5-year and 10-year survival rates were improved in the GITSG study. The EORTC-GITCCG trial could not confirm the benefit of adjuvant radiochemotherapy. This study had a different design than the GITSG trial. Several historical control studies supported the beneficial effect of postoperative radiochemotherapy. In three historical control trials using regional chemotherapy, one with intraoperative radiotherapy , the survival times were improved compared with surgery alone. Intraoperative or postoperative radiotherapy as single modalities might reduce local relapses, but a survival advantage is still debated. Preoperative neoadjuvant radiochemotherapy has several advantages (downstaging, devitalising margins and lymph node metastases, compatibility of treatment vs. postoperative radiochemotherapy), and does not seem to increase the postoperative morbidity. Several trials have confirmed the feasibility of this concept, but no survival advantage has yet been proven. Systemic and regional chemotherapy is able to downstage primarily nonresectable pancreatic cancers. Conclusions: Postoperative adjuvant radiochemotherapy with up-to-date protocols can be recommended for routine treatment, if the surgeon or the patient desires to improve the usually remote prognosis after surgery alone. For those being indecisive or against adjuvant therapy, the participation in trials, e.g. the ESPAC 1 and 2 studies, is strongly recommended. Regarding our own positive experience with adjuvant regional chemotherapy and in view of the postresectional progression pattern, we currently favour adjuvant radiochemotherapy, with the chemotherapy delivered regionally via the celiac axis. This concept will be tested against surgery alone in the ESPAC 2 trial. Neoadjuvant therapies have a g...

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Section: Neoadjuvant Treatmentmentioning

confidence: 96%

Resection and radiochemotherapy of pancreatic cancer – the future?

Link

Formentini²,

Leder³

et al. 1998

Langenbecks Arch Chir

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“…Based on the experience of several institutions with the administration of preoperative radiotherapy for localized pancreatic cancer [7][8][9] and on the evidence suggested by the GITSG phase III trial addressing the radiopotentiating effects of chemotherapy in the adjuvant setting [10], a preoperative chemoradiation therapy pilot study was initiated at Fox Chase Cancer Center in 1986 for patients with potentially resectable stage I to stage III pancreatic cancer [1]. This protocol involved EBRT with a total dose of 5040 cGy in 28 fractions, 180 cGy/fraction, five fractions per week.…”

Section: The 5-fu Experiencementioning

confidence: 99%

Preoperative chemoradiation therapy for adenocarcinoma of the pancreas: The Fox Chase Cancer Center experience, 1986–2003

Meszoely

Wang

Hoffman

2004

Surgical Oncology Clinics of North America

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“…Initial reports of preoperative radiation with or without concurrent 5-FU demonstrated that it could be administered without increased perioperative morbidity and mortality rates [42][43][44][45][46]. However, no obvious improvement in resectability or overall survival was observed.…”

Section: -Fu-based Neoadjuvant Chemoradiation Regimensmentioning

confidence: 99%