Faculty Collaboration Database

Preoperative chemoradiation for patients with pancreatic cancer: toxicity of endobiliary stents. J Clin Oncol 2000 Feb;18(4):860-7

Date

02/16/2000

Pubmed ID

10673529

DOI

10.1200/JCO.2000.18.4.860

Scopus ID

2-s2.0-0033957240 (requires institutional sign-in at Scopus site)   81 Citations

Abstract

PURPOSE: A recent multicenter study of preoperative chemoradiation and pancreaticoduodenectomy for localized pancreatic adenocarcinoma suggested that biliary stent-related complications are frequent and severe and may prevent the delivery of all components of multimodality therapy in many patients. The present study was designed to evaluate the rates of hepatic toxicity and biliary stent-related complications and to evaluate the impact of this morbidity on the delivery of preoperative chemoradiation for pancreatic cancer at a tertiary care cancer center.

PATIENTS AND METHODS: Preoperative chemoradiation was used in 154 patients with resectable pancreatic adenocarcinoma (142 patients, 92%) or other periampullary tumors (12 patients, 8%). Patients were treated with preoperative fluorouracil (115 patients), paclitaxel (37 patients), or gemcitabine (two patients) plus concurrent rapid-fractionation (30 Gy; 123 patients) or standard-fractionation (50.4 Gy; 31 patients) radiation therapy. The incidences of hepatic toxicity and biliary stent-related complications were evaluated during chemoradiation and the immediate 3- to 4-week postchemoradiation preoperative period.

RESULTS: Nonoperative biliary decompression was performed in 101 (66%) of 154 patients (endobiliary stent placement in 77 patients and percutaneous transhepatic catheter placement in 24 patients). Stent-related complications (occlusion or migration) occurred in 15 patients. Inpatient hospitalization for antibiotics and stent exchange was necessary in seven of 15 patients (median hospital stay, 3 days). No patient experienced uncontrolled biliary sepsis, hepatic abscess, or stent-related death.

CONCLUSION: Preoperative chemoradiation for pancreatic cancer is associated with low rates of hepatic toxicity and biliary stent-related complications. The need for biliary decompression is not a clinically significant concern in the delivery of preoperative therapy to patients with localized pancreatic cancer.

Author List

Pisters PW, Hudec WA, Lee JE, Raijman I, Lahoti S, Janjan NA, Rich TA, Crane CH, Lenzi R, Wolff RA, Abbruzzese JL, Evans DB

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
Adult
Aged
Aged, 80 and over
Ampulla of Vater
Antimetabolites, Antineoplastic
Antineoplastic Agents, Phytogenic
Antineoplastic Combined Chemotherapy Protocols
Bile Ducts
Common Bile Duct Neoplasms
Deoxycytidine
Female
Fluorouracil
Follow-Up Studies
Hospitalization
Humans
Incidence
Liver
Male
Middle Aged
Neoadjuvant Therapy
Paclitaxel
Pancreatic Neoplasms
Pancreaticoduodenectomy
Radiotherapy Dosage
Retrospective Studies
Stents