The argument for pre-operative chemoradiation for localized, radiographically resectable pancreatic cancer. Best Pract Res Clin Gastroenterol 2006 Apr;20(2):365-82
Date
03/22/2006Pubmed ID
16549333DOI
10.1016/j.bpg.2005.11.005Scopus ID
2-s2.0-33645016483 (requires institutional sign-in at Scopus site) 46 CitationsAbstract
Although not universally accepted, chemoradiation is considered a standard adjuvant treatment for patients with resected pancreatic cancer. Theoretical advantages of reduced toxicity and increased efficacy with the use of pre-operative chemoradiation compared to post-operative adjuvant chemoradiation have recently been validated with the publication of a phase III trial in the adjuvant treatment of rectal cancer. Additional advantages of pre-operative chemoradiation that apply specifically to pancreatic cancer include increased access to therapy in patients treated before surgery, addressing the systemic disease recurrence risk without delay, and optimal patient selection for pancreaticoduodenectomy through exclusion of patients with rapidly progressive metastatic disease. Critical components of a pre-operative treatment strategy for pancreatic cancer include adherence to a strict definition of resectability, accurate radiographic staging capable of identifying patients with potentially resectable disease, and a safe and efficient means of obtaining a tissue diagnosis and relieving biliary obstruction. Herein, we discuss the rationale for the use of pre-operative chemoradiation in pancreatic cancer, the results of treatment, and future strategies to address the pattern of disease recurrence.
Author List
Crane CH, Varadhachary G, Wolff RA, Pisters PW, Evans DBAuthor
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Angiogenesis InhibitorsAntibodies, Monoclonal
Antibodies, Monoclonal, Humanized
Antimetabolites, Antineoplastic
Bevacizumab
Capecitabine
Deoxycytidine
Fluorouracil
Humans
Neoadjuvant Therapy
Pancreatic Neoplasms
Patient Selection
Postoperative Complications
Radiotherapy Dosage
