Annals of Surgical Oncology

, Volume 17, Issue 8, pp 2092–2101

Unresectable Locally Advanced Pancreatic Cancer: A Multimodal Treatment Using Neoadjuvant Chemoradiotherapy (Gemcitabine Plus Stereotactic Radiosurgery) and Subsequent Surgical Exploration

Authors

    • Department of SurgerySan Bortolo Hospital
    • Department of Medical and Surgical EmergenciesDolo Hospital
  • Giorgio Costantin
    • Department of SurgerySan Bortolo Hospital
  • Franco Casamassima
    • Clinical Radiological InstituteUniversity of Florence
  • Paolo Francescon
    • Service of Medicine Applied PhysicsSan Bortolo Hospital
  • Rosabianca Guglielmi
    • Section of RadiotherapySan Bortolo Hospital
  • Gino Panizzoni
    • Section of RadiotherapySan Bortolo Hospital
  • Antonio Febbraro
    • Department of OncologyFatebenefratelli Hospital
  • Giovanni Ambrosino
    • School of General SurgeryUniversity of Padua
Pancreatic Tumors

DOI: 10.1245/s10434-010-1019-y

Cite this article as:
Polistina, F., Costantin, G., Casamassima, F. et al. Ann Surg Oncol (2010) 17: 2092. doi:10.1245/s10434-010-1019-y

Abstract

Background

Pancreatic cancer accounts for approximately 3% of cancer deaths in Europe. Locally advanced pancreatic cancer (LAPC) involves vascular structures, and resectability is low, with a median survival time of 6 to 11 months. We conducted a prospective, nonrandomized study of patients with LAPC to assess the effect of stereotactic body radiotherapy (SBRT) on local response, pain control, and quality of life (QOL).

Methods

Twenty-three patients with histologically confirmed LAPC underwent SBRT. Radiotherapy (30 Gy) was delivered in three fractions, and treatment toxicity was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE v. 3.0). All patients received also gemcitabine chemotherapy and were followed up until death. Local control was assessed according to Response Evaluation Criteria in Solid Tumors (RECIST) criteria, pain control was assessed with a visual analog scale, and QOL was assessed with the SF-36 instrument (Italian v. 1.6).

Results

No grade 2 or higher acute or late toxicity was observed. The overall local response ratio was 82.6% (14 partial response, 2 complete response, 3 stable disease). SBRT showed a good short-term efficacy in controlling both pain and QOL. Median survival was 10.6 months, with a median follow-up of 9 months. The LAPC became resectable in 8% of the patients. Median time to progression of disease was 7.3 months. Six patients developed early metastatic disease.

Conclusions

The SBRT method is a promising treatment for LAPC. Local control rates, even compared to historical data from conventional radiotherapy, can be achieved with minimal toxicity. Resectability can also be achieved.

Copyright information

© Society of Surgical Oncology 2010