Skip to main content

Advertisement

SpringerLink
Log in

Long-term survival after multimodality treatment for resectable pancreatic cancer

  • Original Article
  • Published:
International Journal of Pancreatology Aims and scope Submit manuscript

Summary

Background. The prognosis of pancreatic adenocarcinoma after radical pancreatectomy is poor, especially in advanced-stage disease.

Study Aim. To determine the survival rates and evaluate the effectiveness of multimodality treatment for advanced pancreatic cancer.

Methods. From November 1983 to January 1993, 30 patients with pancreatic adenocarcinoma including 9 with carcinoma of the body and tail were treated by a multimodal approach consisting of extended pancreatectomy, intraoperative radiotherapy (IORT), and hepatic artery or portal vein infusion of mitomycin C (MMC) followed by systemic bolus injection. All surviving patients were followed for more than 8 yr and survival rates were calculated by the Kaplan-Meier method.

Results. There were no operative or hospital deaths. Eight patients survived for more than 5 yr, 3 of whom survived more than 10 yr. The 5-yr survival rate for 27 patients excluding 3 with metastasis to the liver, peritoneum, or lung was 31%, with a median survival of 31.1 mo. Among them, the 1-, 3-, and 5-yr survival rates for 19 patients with regional nodal metastasis were 95, 50, and 28%, respectively, with a median survival of 36.0 mo.

Conclusion. The multimodality treatment combined with IORT and MMC chemotherapy appeared to have a benefit for prognosis of advanced pancreatic adenocarcinoma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ozaki H, Hojo K, Kato H, Kinoshita T, Egawa S, Kishi K. Multidisciplinary treatment for resectable pancreatic cancer. Int J Pancreatol 1988; 3: 249–259.

    PubMed  CAS  Google Scholar 

  2. Ozaki H, Kinoshita T, Kosuge T, Egawa S, Kishi K. Effectiveness of multimodality treatment for resectable pancreatic cancer. Int J Pancreatol 1990; 7: 195–200.

    PubMed  CAS  Google Scholar 

  3. Seldinger SI. Catheter replacement of the needle in percutaneous arteriography: a new technique. Acta Radiol 1953; 39: 368–376.

    Article  PubMed  CAS  Google Scholar 

  4. Ozaki H, Kinoshita T, Kosuge T, Yamamoto J, Shimada K, Inoue K, et al. An aggressive therapeutic approach to carcinoma of the body and tail of the pancreas. Cancer 1996; 77: 2240–2245.

    Article  PubMed  CAS  Google Scholar 

  5. Sobin LH, Wittekind Ch (eds.). TNM Classification of Malignant Tumours, 5th ed. Wiley-Liss, New York, 1997.

    Google Scholar 

  6. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982; 5: 649–655.

    Article  PubMed  CAS  Google Scholar 

  7. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457–481.

    Article  Google Scholar 

  8. Hermanek P, Sobin LH (eds.). TNM Classification of Malignant Tumours, 4th ed., 2nd rev. Springer-Verlag, Berlin, 1992.

    Google Scholar 

  9. Kalser MH, Ellenberg SS. Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg 1985; 120: 899–903.

    PubMed  CAS  Google Scholar 

  10. Gastrointestinal Tumor Study Group. Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer. Cancer 1987; 59: 2006–2010.

    Article  Google Scholar 

  11. Yeo CJ, Abrams RA, Grochow LB, Sohn TA, Ord SE, Hruban RH, et al. Pancreaticoduodenectomy for pancreatic adenocarcinoma: postoperative adjuvant chemoradiation improves survival. A prospective, single-institution experience. Ann Surg 1997; 225: 621–636.

    Article  PubMed  CAS  Google Scholar 

  12. Klinkenbijl JH, Jeekel J, Sahmoud T, van Pel R, Couvreur ML, Veenhof CH, et al. Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region. Phase III trial of the EORTC Gastrointestinal Tract Cancer Cooperative Group. Ann Surg 1999; 230: 776–784.

    Article  PubMed  CAS  Google Scholar 

  13. Bakkevold KE, Arnesjo B, Dahl O, Kambestad B. Adjuvant combination chemotherapy (AMF) following radical resection of carcinoma of the pancreas and papilla of Vater—results of a controlled, prospective, randomized, multicentre study. Eur J Cancer 1993; 29A: 698–703.

    Article  PubMed  CAS  Google Scholar 

  14. Hiraoka T, Uchino R, Kanemitsu K, Toyonaga M, Saitoh N, Nakamura I, et al. Combination of intraoperative radiation with resection of cancer of the pancreas. Int J Pancreatol 1990; 7: 201–207.

    Article  PubMed  CAS  Google Scholar 

  15. Okamoto A, Tsuruta K, Isawa T, Kamisawa T, Tanaka Y, Onodera T. Intraoperative radiation therapy for pancreatic carcinoma. The choice of treatment modality. Int J Pancreatol 1994; 16: 157–164.

    PubMed  CAS  Google Scholar 

  16. Dobelbower RR, Merrick HW, Khuder S, Battle JA, Herron LM, Pawlicki T. Adjuvant radiation therapy for pancreatic cancer: a 15-year experience. Int J Radiat Oncol Biol Phys 1997; 39: 31–37.

    PubMed  CAS  Google Scholar 

  17. Zerbi A, Fossati V, Parolini D, Carlucci M, Balzano G, Bordogna G, et al. Intraoperative radiation therapy adjuvant to resection in the treatment of pancreatic cancer. Cancer 1994; 73: 2930–2935.

    Article  PubMed  CAS  Google Scholar 

  18. Di Carlo V, Zerbi A, Balzano G, Villa E. Intraoperative and postoperative radiotherapy in pancreatic cancer. Int J Pancreatol 1997; 21: 53–58.

    PubMed  Google Scholar 

  19. Archer SG, Gray BN. Comparison of portal vein chemotherapy with hepatic artery chemotherapy in the treatment of liver micrometastases. Am J Surg 1990; 159: 325–329.

    Article  PubMed  CAS  Google Scholar 

  20. Ozaki H, Hiraoka T, Mizumoto R, Matsuno S, Matsumoto Y, Nakayama T, et al. The prognostic significance of lymph node metastasis and intrapancreatic perineural invasion in pancreatic cancer after curative resection. Surg Today 1999; 29: 16–22.

    Article  PubMed  CAS  Google Scholar 

  21. Takahashi S, Ogata Y, Miyazaki H, Maeda D, Murai S, Yamataka K, et al. Aggressive surgery for pancreatic duct cell cancer: feasibility, validity, limitations. World J Surg 1995; 19: 653–660.

    Article  PubMed  CAS  Google Scholar 

  22. Westerdahl J, Andren-Sandberg A, Ihse I. Recurrence of exocrine pancreatic cancer—local or hepatic? Hepato-Gastroenterology 1993; 40: 384–387.

    PubMed  CAS  Google Scholar 

  23. Baumel H, Huguier M, Manderscheid JC, Fabre JM, Houry S, Fagot H. Results of resection for cancer of the exocrine pancreas: a study from the French Association of Surgery. Br J Surg 1994; 81: 102–107.

    Article  PubMed  CAS  Google Scholar 

  24. Fortner JG, Klimstra DS, Senie RT, Maclean BJ. Tumor size is the primary prognosticator for pancreatic cancer after regional pancreatectomy. Ann Surg 1996; 223: 147–153.

    Article  PubMed  CAS  Google Scholar 

  25. Kloppel G, Lohse T, Bosslet K, Ruckert K. Ductal adenocarcinoma of the head of the pancreas: incidence of tumor involvement beyond the Whipple resection line. Histological and immunocytochemical analysis of 37 total pancreatectomy specimens. Pancreas 1987; 2: 170–175.

    Article  PubMed  CAS  Google Scholar 

  26. Swope TJ, Wade TP, Neuberger TJ, Virgo KS, Jahnson FE. A reappraisal of total pancreatectomy for pancreatic cancer: results from U.S. Veterans Affairs Hospitals, 1987–1991. Am J Surg 1994; 168: 582–586.

    Article  PubMed  CAS  Google Scholar 

  27. Demeure MJ, Doffek KM, Komorowski RA, Redlich PN, Zhu Y-r, Erickson BA, et al. Molecular metastases in stage I pancreatic cancer: improved survival with adjuvant chemoradiation. Surgery 1998; 124: 663–669.

    Article  PubMed  CAS  Google Scholar 

  28. Inoue S, Nakao A, Kasai Y, Harada A, Nonami R, Takagi H. Detection of hepatic micrometastasis in pancreatic adenocarcinoma patients by two-stage polymerase chain reaction/restriction fragment length polymorphism analysis. Jpn J Cancer Res 1995; 86: 626–630.

    PubMed  CAS  Google Scholar 

  29. Trede M, Schwall G, Saeger HD. Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality. Ann Surg 1990; 211: 447–458.

    Article  PubMed  CAS  Google Scholar 

  30. Geer RJ, Brennan MF. Prognostic indicators for survival after resection of pancreatic adenocarcinoma. Am J Surg 1993; 165: 68–73.

    Article  PubMed  CAS  Google Scholar 

  31. Ishikawa O, Ohigashi H, Imaoka S, Sasaki Y, Iwanaga T, Matayoshi Y, et al. Is the long-term survival rate improved by preoperative irradiation prior to Whipple’s procedure for adenocarcinoma of the pancreatic head? Arch Surg 1994; 129: 1075–1080.

    PubMed  CAS  Google Scholar 

  32. Yeo CJ, Cameron JL, Lillemoe KD, Sitzmann JV, Hruban RH, Goodman SN, et al. Pancreaticoduodenectomy for cancer of the head of the pancreas. 201 patients. Ann Surg 1995; 221: 721–733.

    Article  PubMed  CAS  Google Scholar 

  33. Nagakawa T, Nagamori M, Futakami F, Tsukioka Y, Kayahara M, Ohta T, et al. Results of extensive surgery for pancreatic carcinoma. Cancer 1996; 77: 640–645.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiotherapy, National Cancer Center Hospital, Tokyo, Japan

    Koichi Tokuuye

  2. Clinical Laboratory Division, National Cancer Center Hospital, Tokyo, Japan

    Noriyoshi Fukushima

  3. Pathology Division, National Cancer Center Research Institute, Tokyo, Japan

    Kiyoshi Mukai

  4. Department of Surgery, National Cancer Center Hospital, 1-1, Tsukiji 5-Chome, Chuo-ku, 104, Tokyo, Japan

    Hideo Ozaki, Taira Kinoshita, Tomoo Kosuge, Kazuaki Shimada & Junji Yamamoto

Authors
  1. Hideo Ozaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Taira Kinoshita
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tomoo Kosuge
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kazuaki Shimada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Junji Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Koichi Tokuuye
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Noriyoshi Fukushima
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kiyoshi Mukai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hideo Ozaki.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ozaki, H., Kinoshita, T., Kosuge, T. et al. Long-term survival after multimodality treatment for resectable pancreatic cancer. International Journal of Pancreatology 27, 217–224 (2000). https://doi.org/10.1385/IJGC:27:3:217

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1385/IJGC:27:3:217

Key words

Search

Navigation