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.

Results:

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.

Conclusion:

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.

Ergebnisse:

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.

Schlussfolgerung:

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.

Schlüsselwörter:

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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