Strahlentherapie und Onkologie

, Volume 185, Issue 9, pp 557–566 | Cite as

Downstaging of Pancreatic Carcinoma after Neoadjuvant Chemoradiation

  • Dominik Tinkl
  • Gerhard G. Grabenbauer
  • Henriette Golcher
  • Thomas Meyer
  • Thomas Papadopoulos
  • Werner Hohenberger
  • Rolf Sauer
  • Thomas B. Brunner
Original Article

Background and Purpose:

Neoadjuvant chemoradiation could improve survival in patients with pancreatic cancer because of a higher rate of R0 resections, lower rate of nodal metastasis (ypN) and of local recurrence. This approach was tested in a cohort to estimate its effect on survival.

Patients and Methods:

Three-dimensional, conformal radiation to the primary tumor (55.8 Gy) and the lymphatics (50.4 Gy) was combined with chemotherapy. Resection was performed 6 weeks after completion of chemoradiation.


38 of 120 patients with locally advanced cancer underwent tumor resection thereafter. Three patients (8%) had pathologic complete response. Median tumor-specific survival was 29 months and overall survival 25 months. Patients with clear margins (35/38; 89%) had a 3-year disease-specific survival rate of 51% versus 0% with positive margins (p = 0.008). Nodal disease rate decreased from 50% at pretherapeutic imaging to 32% at resection. Patients with ypN0 status (n = 26/38) had a 3-year tumor-specific survival rate of 50% compared to 31% in patients with ypN1 status. At multivariate analysis, resection status and nodal spread significantly predicted tumor-specific survival. Chemoradiation was generally well tolerated.


The current results support randomized testing of neoadjuvant chemoradiation to prove survival prolongation. Compared to the literature this approach seems to reduce the number of positive nodes.

Key Words:

Pancreatic cancer Chemoradiotherapy Neoadjuvant Nodal status Prognosis 

Downstaging von Pankreaskarzinomen nach neoadjuvanter Radiochemotherapie

Hintergrund und Ziel:

Neoadjuvante Radiochemotherapie kann die Überlebenszeit von Patienten mit Pankreaskarzinomen potentiell verlängern, da eine höhere Rate von R0-Resektionen sowie eine niedrigere Rate von Lymphknotenmetastasen (ypN) und Lokalrezidiven erzielt werden. Dazu wurde dieser Ansatz in einer Kohorte von Patienten mit Pankreaskarzinomen untersucht.

Patienten und Methodik:

Der Primärtumor (Dosis 55,8 Gy) und das Lymphabflussgebiet (Dosis 50,4 Gy) wurden dreidimensional konformal bestrahlt mit simultaner Chemotherapie. 6 Wochen danach wurde reseziert.


Die Tumoren von 38 von 120 Patienten mit lokal fortgeschrittenen Tumoren wurden reseziert. Drei Patienten (8%) zeigten eine pathologisch komplette Remission. Die mediane tumorspezifische Überlebenszeit betrug 29 Monate und die mediane Gesamtüberlebenszeit 25 Monate. Patienten mit R0-Resektion (35/38; 89%) wiesen eine krankheitsspezifische 3-Jahres-Überlebensrate von 51% versus 0% nach R1-Resektion auf (p = 0,008). Der Lymphknotenbefall nahm von 50% in der prätherapeutischen Bildgebung auf 32% bei der Resektion ab. Bei Patienten mit ypN0-Status (n = 26/38) fand sich eine krankheitsspezifische 3-Jahres-Überlebensrate von 50% im Vergleich zu 31% bei Patienten mit ypN1-Status. In der multivariaten Analyse waren der Resektionsstatus und der Lymphknotenbefall signifikante Prädiktoren des tumorspezifischen Überlebens. Die Radiochemotherapie wurde generell gut vertragen.


Die Ergebnisse unterstützen die randomisierte Prüfung der neoadjuvanten Radiochemotherapie, um eine Überlebensverlängerung zu bestätigen. Im Literaturvergleich scheint dieser Ansatz die Anzahl befallener Lymphknoten zu reduzieren.


Pankreaskarzinom Radiochemotherapie Neoadjuvant Lymphknotenstatus Prognose 


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Copyright information

© Urban & Vogel, Muenchen 2009

Authors and Affiliations

  • Dominik Tinkl
    • 1
  • Gerhard G. Grabenbauer
    • 1
  • Henriette Golcher
    • 2
  • Thomas Meyer
    • 2
  • Thomas Papadopoulos
    • 3
  • Werner Hohenberger
    • 2
  • Rolf Sauer
    • 1
  • Thomas B. Brunner
    • 1
    • 4
    • 5
  1. 1.Department of Radiation Oncology, Friedrich AlexanderUniversity of Erlangen-NurembergErlangenGermany
  2. 2.Department of General Surgery, Friedrich AlexanderUniversity of Erlangen-NurembergErlangenGermany
  3. 3.Department of Pathology, Friedrich AlexanderUniversity of Erlangen-NurembergErlangenGermany
  4. 4.Gray Institute for Radiation Oncology and BiologyUniversity of OxfordOxfordUK
  5. 5.Radiation Oncology and BiologyUniversity of Oxford, Churchill HospitalHeadington, OxfordUK

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