Faculty Collaboration Database

Preoperative chemoradiation strategies for localized adenocarcinoma of the pancreas. J Hepatobiliary Pancreat Surg 1998;5(3):242-50

Date

01/09/1999

Pubmed ID

9880770

DOI

10.1007/s005340050041

Scopus ID

2-s2.0-0032246066 (requires institutional sign-in at Scopus site)   42 Citations

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.

Author List

Evans DB, Pisters PW, Lee JE, Bold RJ, Charnsangavej C, Janjan NA, Wolff RA, Abbruzzese JL

Author

Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adenocarcinoma
Antimetabolites, Antineoplastic
Chemotherapy, Adjuvant
Fluorouracil
Humans
Pancreatic Neoplasms
Pancreaticoduodenectomy
Preoperative Care
Radiation-Sensitizing Agents
Radiotherapy, Adjuvant