Preoperative chemoradiation in potentially resectable pancreatic adenocarcinoma: feasibility, treatment effect evaluation and prognostic factors, analysis of the SFRO-FFCD 9704 trial and literature review

• Published in: Annals of oncology Vol. 20; no. 8; pp. 1387 - 1396
• Main Authors: Le Scodan, R., Mornex, F., Girard, N., Mercier, C., Valette, P.-J., Ychou, M., Bibeau, F., Roy, P., Scoazec, J.-Y., Partensky, C.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.08.2009; Oxford University Press; Oxford Publishing Limited (England); Elsevier
• Subjects: Adenocarcinoma - therapy; Adult; Aged; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; chemoradiation; Cisplatin - administration & dosage; Feasibility Studies; Female; Fluorouracil - administration & dosage; Gastroenterology. Liver. Pancreas. Abdomen; histopathological response; Humans; Life Sciences; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Neoadjuvant Therapy; neoadjuvant treatment; Neoplasm Recurrence, Local - pathology; pancreatic adenocarcinoma; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - radiotherapy; Pancreatic Neoplasms - surgery; Pancreatic Neoplasms - therapy; Pharmacology. Drug treatments; Survival Rate; Tumors; pancreatic adenocarcinoma; histopathological response; chemoradiation; neoadjuvant treatment; Evaluation; Prognosis; Malignant tumor; Radiotherapy; Neoadjuvant treatment; Anatomic pathology; Chemotherapy; Treatment; Histopathology; Analysis; Pancreas cancer; Digestive diseases; Clinical trial; Feasibility; Combined treatment; Preoperative; Pancreas adenocarcinoma; Bibliographic review; Cancer; Pancreatic disease
• ISSN: 0923-7534; 1569-8041
• DOI: 10.1093/annonc/mdp015

We explored the feasibility and the histologic assessment of treatment effect of preoperative chemoradiation in patients presenting with resectable pancreatic adenocarcinoma. Treatment consisted of concurrent radiotherapy (50 Gy within 5 weeks) and chemotherapy with 5-fluorouracil (300 mg/m2/day, 5 days/week, weeks 1–5) and cisplatin (20 mg/m2/day, days 1–5 and 29–33), followed by surgical resection of the pancreatic tumor in patients without progression. In all, 41 patients were enrolled; 38 (93%) received ≥47 Gy; 30 patients (73%) received ≥75% of the prescribed doses of chemotherapy. Among 40 assessable patients, 27 (67.5%; 95% confidence interval 50.9% to 81.4%) were successfully treated (entire dose of radiation, ≥75% of the chemotherapy dose, no grade 4 non-hematologic toxicity). In all, 26 patients (63%) underwent surgical resection with curative intent and 21 (80.7%) had R0 resection. A total of 13 of 26 specimens (50%) presented a major pathologic response (≥80% of severely degenerative cancer cells), with one complete pathologic response. Operative mortality was 2.8%. The local recurrence and 2-year survival rates were 4% and 32%, respectively, for the 26 operated patients. This proposed preoperative scheme is feasible, does not prevent successful surgery, and provides antitumoral effect associated with major histopathological response in 50% of patients and a high R0 resection rate.