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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, Robert A. Wolff

From the Departments of Surgical Oncology, Gastrointestinal Medical Oncology, Radiation Oncology, Gynecologic Oncology, Pathology, and Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, TX

Corresponding author: Douglas B. Evans, MD, Department of Surgical Oncology, Unit 444, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030; e-mail: devans{at}mdanderson.org

Purpose We conducted a phase II trial to assess the outcomes of patients who received preoperative gemcitabine-based chemoradiation and pancreaticoduodenectomy (PD) for stage I/II pancreatic adenocarcinoma.

Patients and Methods Eligible patients with pancreatic head/uncinate process adenocarcinoma and radiographically defined potentially resectable disease received chemoradiation with 7 weekly intravenous (IV) infusions of gemcitabine (400 mg/m² IV over 30 minutes) plus radiation therapy (30 Gy in 10 fractions over 2 weeks). 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 86 patients. At the time of restaging, disease progression or a decline in performance status precluded 13 patients from surgery. Seventy-three (85%) of 86 patients were taken to surgery, extrapancreatic disease was found in nine, and 64 (74%) of 86 underwent a successful PD. Median overall survival (86 patients) was 22.7 months with a 27% 5-year survival. Median survival was 34 months for the 64 patients who underwent PD and 7 months for the 22 unresected patients (P < .001). The 5-year survival for those who did and did not undergo PD was 36% and 0%, respectively.

Conclusion Preoperative gemcitabine-based chemoradiation followed by restaging and evaluation for surgery separated the study population into two different subsets: patients likely to benefit from PD (n = 64) and those in whom surgery would be unlikely to provide clinical benefit (n = 22). Furthermore, the encouraging overall survival observed in this large trial supports the continued investigation of gemcitabine-based preoperative therapy in resectable pancreatic cancer.

Supported by the Various Donor Fund, the Lockton Fund for Pancreatic Cancer Research at The University of Texas M.D. Anderson Cancer Center, and Eli Lilly & Co.

Presented in part at the 38th Annual Meeting of the American Society of Clinical Oncology, May 18-21, 2002, Orlando, FL.

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

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