Preoperative Paclitaxel and Concurrent Rapid-Fractionation Radiation for Resectable Pancreatic Adenocarcinoma: Toxicities, Histologic Response Rates, and Event-Free Outcome

• Published in: Journal of clinical oncology Vol. 20; no. 10; pp. 2537 - 2544
• Main Authors: PISTERS, Peter W. T, WOLFF, Robert A, EVANS, Douglas B, JANJAN, Nora A, CLEARY, Karen R, CHARNSANGAVEJ, Chusilp, CRANE, Christopher N, LENZI, Renato, VAUTHEY, J. Nicolas, LEE, Jeffrey E, ABBRUZZESE, James L
• Format: Journal Article
• Language: English
• Published: Baltimore, MD American Society of Clinical Oncology 15.05.2002; Lippincott Williams & Wilkins
• Subjects: Adenocarcinoma - drug therapy; Adenocarcinoma - mortality; Adenocarcinoma - radiotherapy; Antineoplastic agents; Antineoplastic Agents, Phytogenic - therapeutic use; Biological and medical sciences; Combined Modality Therapy; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); Disease-Free Survival; Dose Fractionation; Follow-Up Studies; Humans; Medical sciences; Neoplasm Staging; Paclitaxel - therapeutic use; Pancreatectomy; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - radiotherapy; Pharmacology. Drug treatments; Pilot Projects; Survival Rate; Treatment Outcome; Adenocarcinoma; Antineoplastic agent; Human; Prognosis; Duodenum; Intraoperative; Malignant tumor; Radiotherapy; Neoadjuvant treatment; Fractionated dose; Chemotherapy; Radiation dose; Histopathology; Surgery; Taxane derivatives; Paclitaxel; Digestive diseases; Complication; Combined treatment; Preoperative; Pancreas; Antimitotic; Pancreatic disease; Pancreatoduodenectomy
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2002.11.064

To evaluate the toxicity of a preoperative regimen of paclitaxel and concurrent external-beam radiation therapy, pancreaticoduodenectomy, and electron-beam intraoperative radiation therapy (EB-IORT) for patients with resectable pancreatic adenocarcinoma. Patients with localized, potentially resectable pancreatic adenocarcinoma were treated with 30 Gy external-beam radiation therapy and concomitant weekly 3-hour infusions of paclitaxel (60 mg/m(2)). Radiographic restaging was performed 4 to 6 weeks after chemoradiation, and patients with localized disease underwent pancreatectomy with EB-IORT. Thirty-five patients completed chemoradiation; 16 (46%) experienced grade 3 toxicity. Four patients (11%) required hospitalization for dehydration due to grade 3 nausea and vomiting. Twenty (80%) of 25 patients who underwent surgery underwent pancreatectomy; EB-IORT was used in 13 patients. There were no histologic complete responses to preoperative therapy; 21% of specimens demonstrated more than 50% nonviable cells (grade 2b treatment effect). With a median follow-up period of 46 months, the 3-year overall survival rate with chemoradiation and pancreatectomy was 28%. Preoperative paclitaxel-based concurrent chemoradiation is feasible. The toxicity of this regimen seems greater than that with fluorouracil. The histologic responses and survival are similar, suggesting no advantages to paclitaxel-based preoperative treatment.