Unresectable Locally Advanced Pancreatic Cancer: A Multimodal Treatment Using Neoadjuvant Chemoradiotherapy (Gemcitabine Plus Stereotactic Radiosurgery) and Subsequent Surgical Exploration
- 12 March 2010
- journal article
- research article
- Published by Springer Science and Business Media LLC in Annals of Surgical Oncology
- Vol. 17 (8), 2092-2101
- https://doi.org/10.1245/s10434-010-1019-y
Abstract
Pancreatic cancer accounts for approximately 3% of cancer deaths in Europe. Locally advanced pancreatic cancer (LAPC) involves vascular structures, and resectability is low, with a median survival time of 6 to 11 months. We conducted a prospective, nonrandomized study of patients with LAPC to assess the effect of stereotactic body radiotherapy (SBRT) on local response, pain control, and quality of life (QOL). Twenty-three patients with histologically confirmed LAPC underwent SBRT. Radiotherapy (30 Gy) was delivered in three fractions, and treatment toxicity was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE v. 3.0). All patients received also gemcitabine chemotherapy and were followed up until death. Local control was assessed according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria, pain control was assessed with a visual analog scale, and QOL was assessed with the SF-36 instrument (Italian v. 1.6). No grade 2 or higher acute or late toxicity was observed. The overall local response ratio was 82.6% (14 partial response, 2 complete response, 3 stable disease). SBRT showed a good short-term efficacy in controlling both pain and QOL. Median survival was 10.6 months, with a median follow-up of 9 months. The LAPC became resectable in 8% of the patients. Median time to progression of disease was 7.3 months. Six patients developed early metastatic disease. The SBRT method is a promising treatment for LAPC. Local control rates, even compared to historical data from conventional radiotherapy, can be achieved with minimal toxicity. Resectability can also be achieved.Keywords
This publication has 28 references indexed in Scilit:
- Induction Chemotherapy Followed by Chemoradiation in Locally Advanced Pancreatic Cancer: an Effective and Well-tolerated TreatmentClinical Oncology, 2010
- Neoadjuvant chemoradiation and pancreaticoduodenectomy for initially locally advanced head pancreatic adenocarcinomaEuropean Journal of Surgical Oncology, 2009
- Pancreatic cancerDisease-a-Month, 2004
- Current standards of surgery for pancreatic cancerBritish Journal of Surgery, 2004
- Phase I study of stereotactic radiosurgery in patients with locally advanced pancreatic cancerInternational Journal of Radiation Oncology*Biology*Physics, 2004
- Electronic availability of EUROCARE-3 data: a tool for further analysisAnnals of Oncology, 2003
- New Guidelines to Evaluate the Response to Treatment in Solid TumorsJNCI Journal of the National Cancer Institute, 2000
- Pancreatic cancer: a report of treatment and survival trends for 100,313 patients diagnosed from 1985–1995, using the National Cancer DatabaseJournal of the American College of Surgeons, 1999
- An evaluation of radical resection for pancreatic cancer based on the mode of recurrence as determined by autopsy and diagnostic imagingCancer, 1993
- Therapy of locally unresectable pancreatic carcinoma: A randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads + 5-fluorouracil), and high dose radiation + 5-fluorouracil. The gastrointestinal tumor study groupCancer, 1981