Preoperative chemoradiation strategies for localized adenocarcinoma of the pancreas

Douglas B. Evans, Peter W T Pisters, Jeffrey E. Lee, Richard J Bold, C. Charnsangavej, Nora A. Janjan, Robert A. Wolff, James L. Abbruzzese

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Patients who undergo pancreaticoduodenectomy alone for adenocarcinoma of the pancreatic head or uncinate process have a median survival of 12 months, and a high incidence of local tumor recurrence (50%-80%) due to the common finding of positive margins following pathologic evaluation of pancreaticoduodenectomy specimens. The available prospective and retrospective data suggest improved survival duration and local-regional tumor control when pancreaticoduodenectomy is combined with 5-FU-based chemoradiation. However, the morbidity and prolonged recovery associated with pancreaticoduodenectomy frequently prevent the timely delivery of postoperative chemoradiation. In contrast, chemoradiation delivered prior to pancreaticoduodenectomy is not associated with toxic effects which delay surgery and has not been shown to increase surgical morbidity or mortality. In fact, recent data suggest that pancreaticojejunal anastomotic leaks, the most common major complication following pancreaticoduodenectomy, are decreased in patients who receive preoperative radiation therapy. Current and future multimodality treatment strategies will capitalize on our expanding understanding of tumor growth and metastasis, allowing more effective radiation sensitizing agents to be combined with external-beam irradiation and surgery, followed by the systemic or regional delivery of novel agents that inhibit essential steps in tumor cell growth.

Original languageEnglish (US)
Pages (from-to)242-250
Number of pages9
JournalJournal of Hepato-Biliary-Pancreatic Surgery
Volume5
Issue number3
StatePublished - 1998
Externally publishedYes

Fingerprint

Pancreaticoduodenectomy
Pancreas
Adenocarcinoma
Neoplasms
Radiation-Sensitizing Agents
Morbidity
Anastomotic Leak
Survival
Poisons
Growth
Fluorouracil
Radiotherapy
Neoplasm Metastasis
Recurrence
Mortality
Incidence

Keywords

  • Chemoradiation
  • Pancreas cancer
  • Pancreaticoduodenectomy

ASJC Scopus subject areas

  • Surgery

Cite this

Evans, D. B., Pisters, P. W. T., Lee, J. E., Bold, R. J., Charnsangavej, C., Janjan, N. A., ... Abbruzzese, J. L. (1998). Preoperative chemoradiation strategies for localized adenocarcinoma of the pancreas. Journal of Hepato-Biliary-Pancreatic Surgery, 5(3), 242-250.

Preoperative chemoradiation strategies for localized adenocarcinoma of the pancreas. / Evans, Douglas B.; Pisters, Peter W T; Lee, Jeffrey E.; Bold, Richard J; Charnsangavej, C.; Janjan, Nora A.; Wolff, Robert A.; Abbruzzese, James L.

In: Journal of Hepato-Biliary-Pancreatic Surgery, Vol. 5, No. 3, 1998, p. 242-250.

Research output: Contribution to journalArticle

Evans, DB, Pisters, PWT, Lee, JE, Bold, RJ, Charnsangavej, C, Janjan, NA, Wolff, RA & Abbruzzese, JL 1998, 'Preoperative chemoradiation strategies for localized adenocarcinoma of the pancreas', Journal of Hepato-Biliary-Pancreatic Surgery, vol. 5, no. 3, pp. 242-250.
Evans, Douglas B. ; Pisters, Peter W T ; Lee, Jeffrey E. ; Bold, Richard J ; Charnsangavej, C. ; Janjan, Nora A. ; Wolff, Robert A. ; Abbruzzese, James L. / Preoperative chemoradiation strategies for localized adenocarcinoma of the pancreas. In: Journal of Hepato-Biliary-Pancreatic Surgery. 1998 ; Vol. 5, No. 3. pp. 242-250.
@article{6e9bb4c9812e4fd8bd3b39002d952525,
title = "Preoperative chemoradiation strategies for localized adenocarcinoma of the pancreas",
abstract = "Patients who undergo pancreaticoduodenectomy alone for adenocarcinoma of the pancreatic head or uncinate process have a median survival of 12 months, and a high incidence of local tumor recurrence (50{\%}-80{\%}) due to the common finding of positive margins following pathologic evaluation of pancreaticoduodenectomy specimens. The available prospective and retrospective data suggest improved survival duration and local-regional tumor control when pancreaticoduodenectomy is combined with 5-FU-based chemoradiation. However, the morbidity and prolonged recovery associated with pancreaticoduodenectomy frequently prevent the timely delivery of postoperative chemoradiation. In contrast, chemoradiation delivered prior to pancreaticoduodenectomy is not associated with toxic effects which delay surgery and has not been shown to increase surgical morbidity or mortality. In fact, recent data suggest that pancreaticojejunal anastomotic leaks, the most common major complication following pancreaticoduodenectomy, are decreased in patients who receive preoperative radiation therapy. Current and future multimodality treatment strategies will capitalize on our expanding understanding of tumor growth and metastasis, allowing more effective radiation sensitizing agents to be combined with external-beam irradiation and surgery, followed by the systemic or regional delivery of novel agents that inhibit essential steps in tumor cell growth.",
keywords = "Chemoradiation, Pancreas cancer, Pancreaticoduodenectomy",
author = "Evans, {Douglas B.} and Pisters, {Peter W T} and Lee, {Jeffrey E.} and Bold, {Richard J} and C. Charnsangavej and Janjan, {Nora A.} and Wolff, {Robert A.} and Abbruzzese, {James L.}",
year = "1998",
language = "English (US)",
volume = "5",
pages = "242--250",
journal = "Journal of Hepato-Biliary-Pancreatic Sciences",
issn = "1868-6974",
publisher = "Springer Verlag",
number = "3",

}

TY - JOUR

T1 - Preoperative chemoradiation strategies for localized adenocarcinoma of the pancreas

AU - Evans, Douglas B.

AU - Pisters, Peter W T

AU - Lee, Jeffrey E.

AU - Bold, Richard J

AU - Charnsangavej, C.

AU - Janjan, Nora A.

AU - Wolff, Robert A.

AU - Abbruzzese, James L.

PY - 1998

Y1 - 1998

N2 - Patients who undergo pancreaticoduodenectomy alone for adenocarcinoma of the pancreatic head or uncinate process have a median survival of 12 months, and a high incidence of local tumor recurrence (50%-80%) due to the common finding of positive margins following pathologic evaluation of pancreaticoduodenectomy specimens. The available prospective and retrospective data suggest improved survival duration and local-regional tumor control when pancreaticoduodenectomy is combined with 5-FU-based chemoradiation. However, the morbidity and prolonged recovery associated with pancreaticoduodenectomy frequently prevent the timely delivery of postoperative chemoradiation. In contrast, chemoradiation delivered prior to pancreaticoduodenectomy is not associated with toxic effects which delay surgery and has not been shown to increase surgical morbidity or mortality. In fact, recent data suggest that pancreaticojejunal anastomotic leaks, the most common major complication following pancreaticoduodenectomy, are decreased in patients who receive preoperative radiation therapy. Current and future multimodality treatment strategies will capitalize on our expanding understanding of tumor growth and metastasis, allowing more effective radiation sensitizing agents to be combined with external-beam irradiation and surgery, followed by the systemic or regional delivery of novel agents that inhibit essential steps in tumor cell growth.

AB - Patients who undergo pancreaticoduodenectomy alone for adenocarcinoma of the pancreatic head or uncinate process have a median survival of 12 months, and a high incidence of local tumor recurrence (50%-80%) due to the common finding of positive margins following pathologic evaluation of pancreaticoduodenectomy specimens. The available prospective and retrospective data suggest improved survival duration and local-regional tumor control when pancreaticoduodenectomy is combined with 5-FU-based chemoradiation. However, the morbidity and prolonged recovery associated with pancreaticoduodenectomy frequently prevent the timely delivery of postoperative chemoradiation. In contrast, chemoradiation delivered prior to pancreaticoduodenectomy is not associated with toxic effects which delay surgery and has not been shown to increase surgical morbidity or mortality. In fact, recent data suggest that pancreaticojejunal anastomotic leaks, the most common major complication following pancreaticoduodenectomy, are decreased in patients who receive preoperative radiation therapy. Current and future multimodality treatment strategies will capitalize on our expanding understanding of tumor growth and metastasis, allowing more effective radiation sensitizing agents to be combined with external-beam irradiation and surgery, followed by the systemic or regional delivery of novel agents that inhibit essential steps in tumor cell growth.

KW - Chemoradiation

KW - Pancreas cancer

KW - Pancreaticoduodenectomy

UR - http://www.scopus.com/inward/record.url?scp=0032246066&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0032246066&partnerID=8YFLogxK

M3 - Article

C2 - 9880770

AN - SCOPUS:0032246066

VL - 5

SP - 242

EP - 250

JO - Journal of Hepato-Biliary-Pancreatic Sciences

JF - Journal of Hepato-Biliary-Pancreatic Sciences

SN - 1868-6974

IS - 3

ER -