Rapid-fractionation preoperative chemoradiation, pancreaticoduodenectomy, and intraoperative radiation therapy for resectable pancreatic adenocarcinoma.

Pisters, Peter W.T.; Abbruzzese, James L.; Janjan, Nora A.; Cleary, Karen R.; Charnsangavej, Chusilp; Goswitz, Mary S.; Rich, Tyvin A.; Raijman, Isaac; Wolff, Robert A.; Lenzi, Renato; Lee, Jeffrey E.; Evans, Douglas B.

doi:10.1200/jco.1998.16.12.3843

Cited by 226 publications

(118 citation statements)

References 19 publications

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“…Despite significant improvements in operative techniques and mortality rates related to pancreatectomy and the advance of adjuvant chemoradiation therapy, the prognosis for patients with PDA remains unchanged in the last four decades. Neoadjuvant CRT has been increasingly used in patients with potentially resectable PDA and has been shown to improve the survival and locoregional metastatic disease [15,[20][21][22][23]. In this group of patients, the frequency of pCR in subsequent pancreatectomy specimens is largely unknown.…”

Section: Discussionmentioning

confidence: 99%

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

Wang¹,

Zhao²

2012

Annals of Diagnostic Pathology

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In patients with pancreatic ductal adenocarcinoma (PDA) who received neoadjuvant therapy and pancreatectomy, pathologic complete response (pCR) is rarely observed and the prognostic significance of pCR is not clear. In this study, we reported 11 patients with pCR (2.5%) from 442 patients with PDA who received neoadjuvant treatment and pancreatectomy from 1995 to 2010. There were 6 men and 5 women with median age of 61 years. Four patients had either synchronous or prior history of extra-pancreatic cancer. Five patients received neoadjuvant chemotherapy followed by chemoradiation, and 6 received chemoradiation alone. Ten patients had pancreaticoduodenectomy and one had distal pancreatectomy. Scar and chronic pancreatitis consistent with therapy effect were present in all cases (100%). Pancreatic intraepithelial neoplasia 3 (Pan IN3)/carcinoma in situ was present in 5 cases, PanIN1 and PanIN2 in 5 cases. However, no residual invasive carcinoma or lymph node metastasis was identified in all cases. Follow-up information was available in 10 patients. Follow-up time ranges from 6 to 194 months (median, 63 months). During follow-up, three patients died of other causes and one developed a second primary PDA in the tail of pancreas at 84 months after initial pancreaticoduodenectomy and died at 105 months after the initial diagnosis of PDA. The other 6 patients were alive with no evidence of disease. Patients with pCR had better survival than those who had post-therapy stage I or IIA

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Section: Discussionmentioning

confidence: 99%

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

Wang¹,

Zhao²

2012

Annals of Diagnostic Pathology

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“…Gemcitabine and 5-fluorouracil are two of the most commonly used agents that have been evaluated by various investigators as potential neoadjuvant agents [21][22][23][24]. These agents have been tried alone or in conjunction with radiotherapy.…”

Section: For Potentially Resectable Tumorsmentioning

confidence: 99%

Improving Survival of Pancreatic Cancer. What Have We Learnt?

Singh

Chaudhary

2015

Indian J Surg

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Pancreatic adenocarcinoma still ranks high among cancer-related deaths worldwide. In spite of substantial strides in preoperative staging, surgery, perioperative care, and adjuvant treatment, the survival still remains dismal. A number of patient-, disease-, and surgeon-related factors play a role in deciding the eventual outcome of the patient. The aim of this commentary is to review the current knowledge of various factors and the recent advances that impact the survival of patients with pancreatic adenocarcinoma. A search of scientific literature using Embase and MEDLINE, for the years 1985-2015, was carried out for search terms Bpancreatic cancer^and Bsurvival.^Further search was based on the various specific prognostic factors that contribute towards survival of patients with pancreatic cancer found in the literature. Most of the studies used for this review include those that deal with pancreatic head cancers, some include patients with pancreatic cancers in all locations while very few included patients with tumors of body and tail only. In spite of significant developments in pre-and perioperative management, increased rates of margin-negative resections, and use of adjuvant treatment, the survival rates of pancreatic cancer patients remains poor. A paradigm shift with more effective adjuvant regimen and genetic interventions may help change the outcomes of patients with pancreatic cancer.

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“…A possible advantage in survival of using preoperative external radiotherapy and IORT rather than postoperative irradiation emerged also from these data. The preoperative external radiotherapy + IORT was tested at MD Anderson by using a short fractionation of 30 Gy in 10 fraction combined with 5-FU based chemotherapy 45 . Most patients completed the treatment obtaining a 3-year actuarial survival of 23% with only 10% of local failure.…”

Section: Pancreas Cancermentioning

confidence: 99%