CONTEXT: Primary resectability is expected in up to 20% of pancreatic cancer patients. While most patients relapse with distant metastases, approximately 30% of patients show isolated local recurrence without evidence of distant metastases. OBJECTIVE: The present analysis investigates the efficacy of chemoradiotherapy in this particular patient group. DESIGN: Retrospective study. PATIENTS: Eighteen consecutive pancreatic cancer patients presenting with isolated locoregional recurrence after surgical resection. The median interval between primary surgery and diagnosis of local recurrence was 10.4 months (range: 2.0-19.3 months). INTERVENTIONS: Patients received 3-D conformal radiation with 45 Gy in 25 fractions of 1.8 Gy/day. Simultaneous chemotherapy was employed either with continuous 5-FU infusion, partly in combination with gemcitabine, or with gemcitabine and cisplatin. Sequential chemotherapy with gemcitabine and cisplatin was given to some patients before and after the chemoradiotherapy. RESULTS: In 17 of the 18 patients included, radiotherapy was employed at the intended dose. While WHO grade 3-4 gastrointestinal toxicity was not reported, hematotoxicity was more pronounced. Grades 3 and 4 leukocytopenia occurred in 4 patients (22.2%) and 1 (5.6%) patient, respectively, and grades 3 and 4 thrombocytopenia occurred in 4 patients (22.2%) and 1 patient(5.6%), respectively. Six (37.5%) complete remissions, 6 (37.5%) partial remissions, and 4 (25.0%) stable diseases were noted in 16 evaluable patients. Median progression-free survival calculated from the start of the chemoradiotherapy was 14.7 months (range: 8.4-21.0 months) . Seven (28.9%) patients had another local relapse, while 11 (61.1%) patients developed distant metastases. Median overall survival from the start of the chemoradiotherapy was 17.5 months (95% CI: 15.6-19.4 months) and median survival from the initial diagnosis was 27.2 months (95% CI: 23.9-30.6 months). CONCLUSION: The data provide a first indication that chemoradiotherapy is feasible and may be an effective treatment option in those patients who present with local metastasis after primary surgery for pancreatic cancer.
CONTEXT: Primary resectability is expected in up to 20% of pancreatic cancerpatients. While most patients relapse with distant metastases, approximately 30% of patients show isolated local recurrence without evidence of distant metastases. OBJECTIVE: The present analysis investigates the efficacy of chemoradiotherapy in this particular patient group. DESIGN: Retrospective study. PATIENTS: Eighteen consecutive pancreatic cancerpatients presenting with isolated locoregional recurrence after surgical resection. The median interval between primary surgery and diagnosis of local recurrence was 10.4 months (range: 2.0-19.3 months). INTERVENTIONS:Patients received 3-D conformal radiation with 45 Gy in 25 fractions of 1.8 Gy/day. Simultaneous chemotherapy was employed either with continuous 5-FU infusion, partly in combination with gemcitabine, or with gemcitabine and cisplatin. Sequential chemotherapy with gemcitabine and cisplatin was given to some patients before and after the chemoradiotherapy. RESULTS: In 17 of the 18 patients included, radiotherapy was employed at the intended dose. While WHO grade 3-4 gastrointestinal toxicity was not reported, hematotoxicity was more pronounced. Grades 3 and 4 leukocytopenia occurred in 4 patients (22.2%) and 1 (5.6%) patient, respectively, and grades 3 and 4 thrombocytopenia occurred in 4 patients (22.2%) and 1 patient(5.6%), respectively. Six (37.5%) complete remissions, 6 (37.5%) partial remissions, and 4 (25.0%) stable diseases were noted in 16 evaluable patients. Median progression-free survival calculated from the start of the chemoradiotherapy was 14.7 months (range: 8.4-21.0 months) . Seven (28.9%) patients had another local relapse, while 11 (61.1%) patients developed distant metastases. Median overall survival from the start of the chemoradiotherapy was 17.5 months (95% CI: 15.6-19.4 months) and median survival from the initial diagnosis was 27.2 months (95% CI: 23.9-30.6 months). CONCLUSION: The data provide a first indication that chemoradiotherapy is feasible and may be an effective treatment option in those patients who present with local metastasis after primary surgery for pancreatic cancer.
Authors: Kristin M Sheffield; Kristen T Crowell; Yu-Li Lin; Clarisse Djukom; James S Goodwin; Taylor S Riall Journal: Ann Surg Oncol Date: 2011-12-06 Impact factor: 5.344
Authors: Minda A Gowarty; Bassem I Zaki; Michael J Tsapakos; Stuart R Gordon; Arief A Suriawinata; Gregory J Tsongalis; John E Sutton; J Marc Pipas Journal: Gastrointest Cancer Res Date: 2013-07
Authors: Thomas Seufferlein; Marc Porzner; Volker Heinemann; Andrea Tannapfel; Martin Stuschke; Waldemar Uhl Journal: Dtsch Arztebl Int Date: 2014-05-30 Impact factor: 5.594
Authors: Thomas Zacharias; Elie Oussoultzoglou; Daniel Jaeck; Patrick Pessaux; Philippe Bachellier Journal: J Gastrointest Surg Date: 2008-12-03 Impact factor: 3.452
Authors: Aaron T Wild; Susan M Hiniker; Daniel T Chang; Phuoc T Tran; Mouen A Khashab; Maneesha R Limaye; Daniel A Laheru; Dung T Le; Rachit Kumar; Jonathan S Pai; Blaire Hargens; Andrew B Sharabi; Eun Ji Shin; Lei Zheng; Timothy M Pawlik; Christopher L Wolfgang; Albert C Koong; Joseph M Herman Journal: J Gastrointest Oncol Date: 2013-12