Pancreatic resection for pancreatic carcinoma combined with neo- and adjuvant locoregional targeting immuno-chemotherapy--a prospective randomized study

Abstract

Background/aims: The effects on early and late results of combined pancreatic resection with neo- and adjuvant immuno-chemotherapy for patients undergoing pancreatic resection are prospectively evaluated.

Methodology: A group of 26 patients was divided into two groups, which were matched in terms of age-sex ratio, stage of disease, histological diagnosis and mode of pancreatic resection. Group A patients received a multimodality therapy, combining pancreatic resection with neo- and adjuvant locoregional targeting immunochemotherapy. Group B received pancreatic surgery only.

Results: For Group A patients (n = 14pts), a complete response was seen in 11 patients with a time interval ranging from 9 to 29 months. In the remaining 3 patients liver secondaries developed 12 months after pancreatic resection in 2 patients and the other patient developed pulmonary metastases 22 months after pancreatic resection. All patients (n = 3pts) are alive, but continue to have the disease. For Group B patients (n = 12pts), a complete response was seen in 3 patients with a survival of 9, 10 and 20 months following pancreatic resection. Six patients died due to locoregional recurrence of the disease, with the survival rate ranging from 7 to 18 months (mean 10 months). Locoregional recurrence was complicated with liver secondaries (n = 3) and with peritoneal dissemination of the disease in a further 3 patients. The remaining 3 patients are alive, but continue to have the disease due to locoregional recurrence.

Conclusions: Patients in whom neo- and adjuvant locoregional immunochemotherapy was carried out in conjunction with pancreatic resection, demonstrated a significantly higher response rate to treatment. Therefore the data collected offers clear evidence, regarding the usefulness, applicability and safety of combined neo- and adjuvant therapy with pancreatic resection. A Multi-modality approach is therefore highly recommended.