Yoshito Tomimaru1, Hidetoshi Eguchi2, Yoshifumi Iwagami1, Hirofumi Akita1, Takehiro Noda1, Kunihito Gotoh1, Shogo Kobayashi1, Hiroaki Nagano1,3, Masaki Mori1,4, Yuichiro Doki1. 1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka E-2, Suita, Osaka, 565-0871, Japan. 2. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka E-2, Suita, Osaka, 565-0871, Japan. heguchi@gesurg.med.osaka-u.ac.jp. 3. Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan. 4. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Abstract
PURPOSE: Preoperative chemoradiotherapy (CRT) can be a promising treatment for pancreatic ductal adenocarcinoma (PDAC). However, its administration for patients with impaired renal function has not been well investigated, let alone its clinical effect. We previously reported preliminary feasibility of CRT in PDAC patients with renal impairment. Herein, we aimed to investigate the clinical effects of preoperative CRT including safety and long-term prognosis in more PDAC patients with renal impairment as an extension to our previous work. METHODS: This study enrolled twenty patients harboring resectable PDAC with creatinine clearance level less than 60 ml/min. Patients underwent preoperative CRT with gemcitabine, followed by surgery. The clinical effects of the therapy were evaluated in terms of safety and long-term prognosis. RESULTS: Preoperative CRT was completed in all 20 patients. Grade 4 leukopenia/neutropenia was identified as an observed toxicity in four cases (20.0%). Renal function was not worsened after CRT. After CRT, 17 cases were judged resectable and underwent laparotomy. Pancreatic resection was performed in 15 of the 17 patients; it was not performed in two patients because of peritoneal dissemination. The 1-/3-/5-year cumulative survival rate from the initiation of CRT for the 20 patients was 88.8%/45.5%/22.8%. In the 15 patients, renal function was not worsened after surgery. CONCLUSION: Our findings suggest that the clinical effects of preoperative CRT would be favorable in PDAC patients with renal impairment.
PURPOSE: Preoperative chemoradiotherapy (CRT) can be a promising treatment for pancreatic ductal adenocarcinoma (PDAC). However, its administration for patients with impaired renal function has not been well investigated, let alone its clinical effect. We previously reported preliminary feasibility of CRT in PDACpatients with renal impairment. Herein, we aimed to investigate the clinical effects of preoperative CRT including safety and long-term prognosis in more PDACpatients with renal impairment as an extension to our previous work. METHODS: This study enrolled twenty patients harboring resectable PDAC with creatinine clearance level less than 60 ml/min. Patients underwent preoperative CRT with gemcitabine, followed by surgery. The clinical effects of the therapy were evaluated in terms of safety and long-term prognosis. RESULTS: Preoperative CRT was completed in all 20 patients. Grade 4 leukopenia/neutropenia was identified as an observed toxicity in four cases (20.0%). Renal function was not worsened after CRT. After CRT, 17 cases were judged resectable and underwent laparotomy. Pancreatic resection was performed in 15 of the 17 patients; it was not performed in two patients because of peritoneal dissemination. The 1-/3-/5-year cumulative survival rate from the initiation of CRT for the 20 patients was 88.8%/45.5%/22.8%. In the 15 patients, renal function was not worsened after surgery. CONCLUSION: Our findings suggest that the clinical effects of preoperative CRT would be favorable in PDACpatients with renal impairment.
Authors: Helmut Oettle; Stefan Post; Peter Neuhaus; Klaus Gellert; Jan Langrehr; Karsten Ridwelski; Harald Schramm; Joerg Fahlke; Carl Zuelke; Christof Burkart; Klaus Gutberlet; Erika Kettner; Harald Schmalenberg; Karin Weigang-Koehler; Wolf-Otto Bechstein; Marco Niedergethmann; Ingo Schmidt-Wolf; Lars Roll; Bernd Doerken; Hanno Riess Journal: JAMA Date: 2007-01-17 Impact factor: 56.272
Authors: Helmut Oettle; Peter Neuhaus; Andreas Hochhaus; Jörg Thomas Hartmann; Klaus Gellert; Karsten Ridwelski; Marco Niedergethmann; Carl Zülke; Jörg Fahlke; Michael B Arning; Marianne Sinn; Axel Hinke; Hanno Riess Journal: JAMA Date: 2013-10-09 Impact factor: 56.272
Authors: John P Neoptolemos; Deborah D Stocken; Helmut Friess; Claudio Bassi; Janet A Dunn; Helen Hickey; Hans Beger; Laureano Fernandez-Cruz; Christos Dervenis; François Lacaine; Massimo Falconi; Paolo Pederzoli; Akos Pap; David Spooner; David J Kerr; Markus W Büchler Journal: N Engl J Med Date: 2004-03-18 Impact factor: 91.245
Authors: Douglas B Evans; Gauri R Varadhachary; Christopher H Crane; Charlotte C Sun; Jeffrey E Lee; Peter W T Pisters; Jean-Nicolas Vauthey; Huamin Wang; Karen R Cleary; Gregg A Staerkel; Chusilp Charnsangavej; Elizabeth A Lano; Linus Ho; Renato Lenzi; James L Abbruzzese; Robert A Wolff Journal: J Clin Oncol Date: 2008-07-20 Impact factor: 44.544