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. 2012 Mar 2:7:28.
doi: 10.1186/1748-717X-7-28.

Neoadjuvant chemoradiation with Gemcitabine for locally advanced pancreatic cancer

Daniel Habermehl  1 , Kerstin Kessel, Thomas Welzel, Holger Hof, Amir Abdollahi, Frank Bergmann, Stefan Rieken, Jürgen Weitz, Jens Werner, Peter Schirmacher, Markus W Büchler, Jürgen Debus, Stephanie E Combs
Affiliations

Neoadjuvant chemoradiation with Gemcitabine for locally advanced pancreatic cancer

Daniel Habermehl et al. Radiat Oncol. .

Abstract

Introduction: To evaluate efficacy and secondary resectability in patients with locally advanced pancreatic cancer (LAPC) treated with neoadjuvant chemoradiotherapy (CRT).

Patients and methods: A total of 215 patients with locally advanced pancreatic cancer were treated with chemoradiation at a single institution. Radiotherapy was delivered with a median dose of 52.2 Gy in single fractions of 1.8 Gy. Chemotherapy was applied concomitantly as gemcitabine (GEM) at a dose of 300 mg/m2 weekly, followed by adjuvant cycles of full-dose GEM (1000 mg/m2). After neoadjuvant CRT restaging was done to evaluate secondary resectability. Overall and disease-free survival were calculated and prognostic factors were estimated.

Results: After CRT a total of 26% of all patients with primary unresectable LAPC were chosen to undergo secondary resection. Tumour free resection margins could be achieved in 39.2% (R0-resection), R1-resections were seen in 41.2%, residual macroscopic tumour in 11.8% (R2) and in 7.8% resection were classified as Rx. Patients with complete resection after CRT showed a significantly increased median overall survival (OS) with 22.1 compared to 11.9 months in non-resected patients. Median OS and disease-free survival (DFS) of all patients were 12.3 and 8.1 months respectively. In most cases the first site of disease progression was systemic with hepatic (52%) and peritoneal (36%) metastases.

Discussion: A high percentage of patients with locally advanced pancreatic cancer can undergo secondary resection after gemcitabine-based chemoradiation and has a relative long-term prognosis after complete resection.

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Figures

Figure 1
Figure 1
CT scan of a female patient before (A) and after (C) neoadjuvant CRT showing a partial remission of the pancreatic tumour. Dose distribution of the applied treatment plan (B).
Figure 2
Figure 2
Kaplan-Meier estimate of overall survival (OS) of all patients.
Figure 3
Figure 3
Kaplan-Meier estimates comparing survival of resected patients and non-resected patients after neoadjuvant CRT.
Figure 4
Figure 4
Kaplan-Meier estimate for overall survival (OS) of patients according to resection status.
Figure 5
Figure 5
Kaplan-Meier estimate for disease-free survival (DFS) of resected and unresected patients.
See this image and copyright information in PMC

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