Abstract
Background
Pancreatic carcinoma causes more than 20,000 deaths every year in Japan. The role of (neo-) adjuvant chemotherapy for pancreatic carcinoma is still controversial.
Methods
At the 34th Annual Meeting of the Japanese Society of Pancreatic Surgery in 2007, questionnaires were distributed regarding the use of (neo-) adjuvant chemo(radio)therapy for pancreatic carcinoma between 2001 and 2005.
Results
Sixty of the 146 member institutions responded to the questionnaires. There were a total of 1,846 cases of resected pancreatic carcinoma between 2001 and 2005. The study population had a greater proportion of males, and a mean age of 65.3 years (range 34–90 years). The lesion was located in the head of the pancreas in 1,204 cases (71.7%), in the body in 353 cases (21.0%), and in the tail in 111 cases (6.6%). Overall survival rates were 67.3% at 1 year, 36.0% at 2 years, and 23.9% at 3 years, respectively. Adjuvant chemotherapy (usually involving gemcitabine) was used in 66.0% of cases. The use of adjuvant chemotherapy was found to improve the overall survival rate. Interestingly, adjuvant chemotherapy only improved survival in late-stage (UICC stages IIB, III, and IV) but not early stage (IA, IB, and IIA) patients. Survival was treatment duration-dependent, with patients who received more than 12 months of therapy having a 3-year survival rate of 51.2%.
Conclusion
This high volume retrospective data indicated the promising effect of gemcitabine-based adjuvant chemotherapy and the rational duration of adjuvant chemotherapy should be determined in the future prospective studies.
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References
The website of Japanese Ministry of Health, Labour and Welfare [http://www.mhlw.go.jp/toukei/].
Fortner JG. Regional pancreatectomy for carcinoma of the pancreas, ampulla, and other related sites. Tumor staging and results. Ann Surg. 1984;199:418–25.
Pedrazzoli S, DiCarlo V, Dionigi R, Mosca F, Pederzoli P, Pasquali C, et al. Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group. Ann Surg. 1998;228:508–17.
Yeo CJ, Cameron JL, Lillemoe KD, Sohn TA, Campbell KA, Sauter PK, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg. 2002;236:355–66.
Nguyen TC, Sohn TA, Cameron JL, Lillemoe KD, Campbell KA, Coleman J, et al. Standard vs radical pancreaticoduodenectomy for periampullary adenocarcinoma: a prospective, randomized trial evaluating quality of life in pancreaticoduodenectomy survivors. J Gastrointest Surg. 2003;7:1–9.
Burris HAIII, Moore MJ, Andersen J, Green MR, Rothenberg ML, Modiano MR, et al. Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol. 1997;15:2403–13.
Bonadonna G, Moliterni A, Zambetti M, Daidone MG, Pilotti S, Gianni L, et al. 30 Years’ follow up of randomised studies of adjuvant CMF in operable breast cancer cohort study. BMJ. 2005;330:217.
Citron ML, Berry DA, Cirrincione C, Hudis C, Winer EP, Gradishar WJ, et al. Randomized trial of dose-dense versus conventionally scheduled and sequential versus concurrent combination chemotherapy as postoperative adjuvant treatment of node-positive primary breast cancer: first report of Intergroup Trial C9741/Cancer and Leukemia Group B Trial 9741. J Clin Oncol. 2003;21:1431–9.
Martin M, Pienkowski T, Mackey J, Pawlicki M, Guastalla JP, Weaver C, et al. Breast Cancer International Research Group 001 Investigators. Adjuvant docetaxel for node-positive breast cancer. N Engl J Med. 2005;352:2302–13.
Leichman CG. Adjuvant therapy for colon cancer 2005: new options in the twenty-first century. Surg Oncol Clin North Am. 2006;15:159–73.
Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, et al. ACTS-GC Group. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007;357:1810–20.
Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA. 2007;297:267–77.
The committee of pancreatic carcinoma registration of Japan Pancreas Society. Summary of 20-years registration of pancreatic carcinoma conducted by JPS. Pancreas [Japanese edition]. 2003;18:97–169.
Kalser MH, Ellenberg SS. Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg. 1985;120:899–903.
Gastrointestinal Tumor Study Group. Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer. Cancer. 1987;59:2006–10.
Yeo CJ, Abrams RA, Grochow LB, Sohn TA, Ord SE, Hruban RH. Pancreaticoduodenectomy for pancreatic adenocarcinoma: postoperative adjuvant chemoradiation improves survival. A prospective, single-institution experience. Ann Surg. 1997;225:621–33.
Sohn TA, Yeo CJ, Cameron JL, Koniaris L, Kaushal S, Abrams RA, et al. Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg. 2000;4:567–79.
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;230:776–84.
Bakkevold KE, Arnesjø 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, randomised multicentre study. Eur J Cancer. 1993;29A:698–703.
Neoptolemos JP, Dunn JA, Stocken DD, Almond J, Link K, Beger H, et al. European Study Group for Pancreatic Cancer. Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomised controlled trial. Lancet. 2001;358:1576–85.
Takada T, Amano H, Yasuda H, Nimura Y, Matsushiro T, Kato H, et al. Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase III multicenter prospective randomized controlled trial in patients with resected pancreaticobiliary carcinoma. Caner. 2002;95:1685–95.
Kosuge T, Kiuchi T, Mukai K, Kakizoe T, Japanese Study Group of Adjuvant Therapy for Pancreatic Cancer (JSAP). A multicenter randomized controlled trial to evaluate the effect of adjuvant cisplatin and 5-fluorouracil therapy after curative resection in cases of pancreatic cancer. Jpn J Clin Oncol. 2006;36:159–65.
Ueno H, Okusaka T, Ikeda M, Takezako Y, Morizane C. An early phase II study of S-1 in patients with metastatic pancreatic cancer. Oncology. 2005;68:171–8.
Nakamura K, Yamaguchi T, Ishihara T, Sudo K, Kato H, Saisho H. Phase II trial of oral S-1 combined with gemcitabine in metastatic pancreatic cancer. Br J Cancer. 2006;94:1575–9.
Okusaka T, Funakoshi A, Furuse J, Boku N, Yamao K, Ohkawa S, et al. A late phase II study of S-1 for metastatic pancreatic cancer. Cancer Chemother Pharmacol. 2008;61:615–21.
Ueno H, Okusaka T, Ikeda M, Ishiguro Y, Morizane C, Matsubara J, et al. A phase I study of combination chemotherapy with gemcitabine and oral S-1 for advanced pancreatic cancer. Oncology. 2005;69:421–7.
Nakamura K, Yamaguchi T, Ishihara T, Kobayashi A, Tadenuma H, Sudo K, et al. Phase I trial of oral S-1 combined with gemcitabine in metastatic pancreatic cancer. Br J Cancer. 2005;92:2134–9.
Shinchi H, Maemura K, Noma H, Mataki Y, Aikou T, Takao S. Phase-I trial of oral fluoropyrimidine anticancer agent (S-1) with concurrent radiotherapy in patients with unresectable pancreatic cancer. Br J Cancer. 2007;96:1353–7.
Sudo K, Yamaguchi T, Ishihara T, Nakamura K, Shirai Y, Nakagawa A, et al. Phase I study of oral S-1 and concurrent radiotherapy in patients with unresectable locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys. 2007;67:219–24.
Maeda A, Boku N, Fukutomi A, Kondo S, Kinoshita T, Nagino M, et al. Randomized phase III trial of adjuvant chemotherapy with gemcitabine versus S-1 in patients with resected pancreatic cancer: Japan Adjuvant Study Group of Pancreatic Cancer (JASPAC-01). Jpn J Clin Oncol. 2008;38:227–79.
Acknowledgments
The authors are especially grateful to the 60 leading Japanese institutions that kindly took part in the survey.
Aichi Medical University, Department of Surgery; Division of Gastroenterol Surgery
Asahikawa Medical College, Department of Gastroenterological Surgery
Chiba Cancer Center, Department of Gastroenterological Surgery
Chiba Rosai Hospital, Department of Surgery
Fujita Health University School of Medicine, Department of Biliary Pancreatic Surgery
Fukui University, Faculty of Medicine, Department of Surgery I
Higashiosaka City General Hospital, Department of Surgery
Hirosaki University School of Medicine, Department of Surgery II
Hiroshima City Hospital, Department of Surgery
Hyogo College of Medicine, Department of Surgery 1
Ikuwakai Memorial Hospital, Department of Surgery
Ise Municipal General Hospital, Department of Surgery
Iwate Medical University School of Medicine, Department of Surgery
Jichi Medical University, Department of Surgery
Jikei University School of Medicine, Department of Surgery
Jikei University School of Medicine, Aoto Hospital, Department of Surgery
Jikei University, Daisan Hospital, Department of Surgery
Jikei University, Kashiwa Hospital, Department of Surgery
Kagawa University, Faculty of Medicine, Department of Gastroenterological Surgery
Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Department of Surgery
Kitakyushu Municipal Medical Center, Department of Surgery
Kitasato University School of Medicine, Department of Surgery
Kobe City Medical Center General Hospital, Department of Surgery
Kobe University Graduate School of Medicine, Department of Hepato-Billiary-Pancreatic Surgery
Kurume University School of Medicine, Department of Surgery
Kyorin University School of Medicine, Department of Surgery
Kyushu University, Faculty of Medicine, Department of Surgery I
Matsusaka City Hospital, Department of Surgery
Meiwa Hospital, Department of Surgery
Miyazaki University School of Medicine, Department of Surgical Oncology and Regulation of Organ Function
Nagasaki University Graduate School of Medicine, Department of Gastroenterological Surgery
Nagoya City University Graduate School of Medical Sciences, Department of Gastroenterological Surgery
Nagoya University Graduate School of Medicine, Department of Gastroenterological Surgery
Nara Medical University, Department of Surgery
National Cancer Center Hospital East, Department of Upper Abdominal Surgery
National Kyushu Cancer Center, Department of Surgery
National Kyushu Medical Center, Department of Surgery
Nihon University School of Medicine, Division of Digestive Surgery
Niigata Prefectural Central Hospital, Department of Surgery
Niigata University School of Medicine, Department of Surgery
Nippon Medical School, Department of Surgery I
Okayama University Graduate School of Medicine, Department of Gastroenterological surgery transplant and Surgical Oncology
Osaka City University Graduate School of Medicine, Department of Hepato-Billiary-Pancreatic Surgery
Osaka City University Graduate School of Medicine, Department of Surgical Oncology
Osaka Rosai Hospital, Department of Surgery
Osaka University Graduate School of Medicine, Department of Gastroentelogical Surgery
Sapporo Medical University, Department of Surgery I
Sapporo-Kosei general Hospital, Department of Surgery
Shinshu University School of Medicine, Department of Surgery
Showa University School of Medicine, Department of Surgery
St. Marianna University School of Medicine, Department of Surgery
St. Marianna University, Yokohama City Seibu Hospital, Department of Surgery
Teikyo University Chiba Medical Center, Department of Surgery
Tochigi Cancer Center, Department of Surgery
Toho University Ohashi Medical Center, Department of Surgery III
Tokyo Medical University, Department of Surgery
Tokyo Women’s Medical University Medical Center East, Department of Surgery
Tokyo Women’s Medical University, Institute of Gastroenterology, Department of Gastroenterological Surgery
Wakayama Medical University, Department of Gastroenterological Surgery
Yamaguchi University Graduate School of Medicine, Department of Digestive Surgery and Surgical Oncology.
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Sata, N., Kurashina, K., Nagai, H. et al. The effect of adjuvant and neoadjuvant chemo(radio)therapy on survival in 1,679 resected pancreatic carcinoma cases in Japan: report of the national survey in the 34th annual meeting of Japanese Society of Pancreatic Surgery. J Hepatobiliary Pancreat Surg 16, 485–492 (2009). https://doi.org/10.1007/s00534-009-0077-7
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DOI: https://doi.org/10.1007/s00534-009-0077-7