This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Varadhachary, G. R. Articles by Evans, D. B. Search for Related Content PubMed PubMed Citation Articles by Varadhachary, G. R. Articles by Evans, D. B. Related Articles Related Articles Related Editorial Social Bookmarking                            What's this?

Preoperative Gemcitabine and Cisplatin Followed by Gemcitabine-Based Chemoradiation for Resectable Adenocarcinoma of the Pancreatic Head

Gauri R. Varadhachary, Robert A. Wolff, Christopher H. Crane, Charlotte C. Sun, Jeffrey E. Lee, Peter W.T. Pisters, Jean-Nicolas Vauthey, Eddie Abdalla, Huamin Wang, Gregg A. Staerkel, Jeffrey H. Lee, William A. Ross, Eric P. Tamm, Priya R. Bhosale, Sunil Krishnan, Prajnan Das, Linus Ho, Henry Xiong, James L. Abbruzzese, Douglas B. Evans

From the Departments of Gastrointestinal Medical Oncology, Radiation Oncology, Gynecologic Oncology, Surgical Oncology, Pathology, Gastroenterology, Hepatology, Nutrition, and Diagnostic Imaging; The University of Texas M.D. Anderson Cancer Center, Houston; and the Center for Cancer and Blood Disorders, Fort Worth, TX

Corresponding author: Gauri R. Varadhachary, MD, Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Box 426, Houston, TX 77030; e-mail: gvaradha{at}mdanderson.org

Purpose We conducted a phase II trial of preoperative gemcitabine and cisplatin chemotherapy in addition to chemoradiation (Gem-Cis-XRT) and pancreaticoduodenectomy (PD) for patients with stage I/II pancreatic adenocarcinoma.

Patients and Methods Chemotherapy consisted of gemcitabine (750 mg/m²) and cisplatin (30 mg/m²) given every 2 weeks for four doses. Chemoradiation consisted of four weekly infusions of gemcitabine (400 mg/m²) combined with radiation therapy (30 Gy in 10 fractions administered over 2 weeks) delivered 5 days per week. Patients underwent restaging 4 to 6 weeks after completion of chemoradiation and, in the absence of disease progression, were taken to surgery.

Results The study enrolled 90 patients; 79 patients (88%) completed chemo-chemoradiation. Sixty-two (78%) of 79 patients were taken to surgery and 52 (66%) of 79 underwent PD. The median overall survival of all 90 patients was 17.4 months. Median survival for the 79 patients who completed chemo-chemoradiation was 18.7 months, with a median survival of 31 months for the 52 patients who underwent PD and 10.5 months for the 27 patients who did not undergo surgical resection of their primary tumor (P < .001).

Conclusion Preoperative Gem-Cis-XRT did not improve survival beyond that achieved with preoperative gemcitabine-based chemoradiation (Gem-XRT) alone. The longer preoperative interval required more durable biliary decompression (metal stents) but was not associated with local tumor progression. The gemcitabine-based chemoradiation platform is a reasonable foundation on which to build future phase II multimodality trials for stage I/II pancreatic cancer incorporating emerging systemic therapies.

Supported by the Various Donor Fund for Pancreatic Cancer Research and National Institutes of Health Grant No. CA101936-01 (Specialized Programs of Research Excellence in Pancreatic Cancer) at The University of Texas M.D. Anderson Cancer Center (data management support). Research support provided by Eli Lilly Corporation.

Presented in part at the Gastrointestinal Cancer Symposium, 42nd Annual Meeting of the American Society of Clinical Oncology, June 2-6, 2006 Atlanta, GA (abstr 95).

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

Related Articles

• Preoperative Gemcitabine-Based Chemoradiation for Patients With Resectable Adenocarcinoma of the Pancreatic Head
  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, and Robert A. Wolff
  JCO 2008 26: 3496-3502 [Abstract] [Full Text]
• Analysis of Fluorouracil-Based Adjuvant Chemotherapy and Radiation After Pancreaticoduodenectomy for Ductal Adenocarcinoma of the Pancreas: Results of a Large, Prospectively Collected Database at the Johns Hopkins Hospital
  Joseph M. Herman, Michael J. Swartz, Charles C. Hsu, Jordan Winter, Timothy M. Pawlik, Elizabeth Sugar, Ray Robinson, Daniel A. Laheru, Elizabeth Jaffee, Ralph H. Hruban, Kurtis A. Campbell, Christopher L. Wolfgang, Fariba Asrari, Ross Donehower, Manuel Hidalgo, Luis A. Diaz, Jr, Charles Yeo, John L. Cameron, Richard D. Schulick, and Ross Abrams
  JCO 2008 26: 3503-3510 [Abstract] [Full Text]
• Adjuvant Radiotherapy and Chemotherapy for Pancreatic Carcinoma: The Mayo Clinic Experience (1975-2005)
  Michele M. Corsini, Robert C. Miller, Michael G. Haddock, John H. Donohue, Michael B. Farnell, David M. Nagorney, Aminah Jatoi, Robert R. McWilliams, George P. Kim, Sumita Bhatia, Matthew J. Iott, and Leonard L. Gunderson
  JCO 2008 26: 3511-3516 [Abstract] [Full Text]

Related Editorial

• Past and Future of Pancreas Cancer: Are We Ready to Move Forward Together?
  Nipun Merchant and Jordan Berlin
  JCO 2008 26: 3478-3480 [Full Text]

This article has been cited by other articles:

				N. A. van der Gaag, E. A.J. Rauws, C. H.J. van Eijck, M. J. Bruno, E. van der Harst, F. J.G.M. Kubben, J. J.G.M. Gerritsen, J. W. Greve, M. F. Gerhards, I. H.J.T. de Hingh, et al. Preoperative Biliary Drainage for Cancer of the Head of the Pancreas N. Engl. J. Med., January 14, 2010; 362(2): 129 - 137. [Abstract] [Full Text] [PDF]

				T. H. Baron and R. A. Kozarek Preoperative Biliary Stents in Pancreatic Cancer -- Proceed with Caution N. Engl. J. Med., January 14, 2010; 362(2): 170 - 172. [Full Text] [PDF]

				C. Larbouret, B. Robert, C. Bascoul-Mollevi, F. Penault-Llorca, A. Ho-Pun-Cheung, S. Morisseau, I. Navarro-Teulon, J.-P. Mach, A. Pelegrin, and D. Azria Combined cetuximab and trastuzumab are superior to gemcitabine in the treatment of human pancreatic carcinoma xenografts Ann. Onc., January 1, 2010; 21(1): 98 - 103. [Abstract] [Full Text] [PDF]

				T. Okazaki, M. Javle, M. Tanaka, J. L. Abbruzzese, and D. Li Single Nucleotide Polymorphisms of Gemcitabine Metabolic Genes and Pancreatic Cancer Survival and Drug Toxicity Clin. Cancer Res., January 1, 2010; 16(1): 320 - 329. [Abstract] [Full Text] [PDF]

				R. Le Scodan, F. Mornex, N. Girard, C. Mercier, P.-J. Valette, M. Ychou, F. Bibeau, P. Roy, J.-Y. Scoazec, and C. Partensky Preoperative chemoradiation in potentially resectable pancreatic adenocarcinoma: feasibility, treatment effect evaluation and prognostic factors, analysis of the SFRO-FFCD 9704 trial and literature review Ann. Onc., August 1, 2009; 20(8): 1387 - 1396. [Abstract] [Full Text] [PDF]

				X. Dong, L. Jiao, Y. Li, D. B. Evans, H. Wang, K. R. Hess, J. L. Abbruzzese, and D. Li Significant Associations of Mismatch Repair Gene Polymorphisms With Clinical Outcome of Pancreatic Cancer J. Clin. Oncol., April 1, 2009; 27(10): 1592 - 1599. [Abstract] [Full Text] [PDF]

				N. Merchant and J. Berlin Past and Future of Pancreas Cancer: Are We Ready to Move Forward Together? J. Clin. Oncol., July 20, 2008; 26(21): 3478 - 3480. [Full Text] [PDF]

				D. B. Evans, G. R. Varadhachary, C. H. Crane, C. C. Sun, J. E. Lee, P. W.T. Pisters, J.-N. Vauthey, H. Wang, K. R. Cleary, G. A. Staerkel, et al. Preoperative Gemcitabine-Based Chemoradiation for Patients With Resectable Adenocarcinoma of the Pancreatic Head J. Clin. Oncol., July 20, 2008; 26(21): 3496 - 3502. [Abstract] [Full Text] [PDF]