Neoadjuvant therapy for unresectable pancreatic adenocarcinoma
J. M. Jessup, G. Steele Jr, R. J. Mayer, M. Posner, P. Busse, B. Cady, M. Stone, R. Jenkins and R. Osteen
Department of Surgery, New England Deaconess Hospital, Boston, Mass.
The purposes of this study were to determine whether continuous infusion of
fluorouracil combined with external-beam radiation therapy improved the
resectability and survival of patients with pancreatic carcinoma. Sixteen
patients with unresectable disease confined to the pancreas and celiac
nodes were treated, and their outcome was compared with that of 24 patients
with potentially resectable disease who were treated concurrently. The
neoadjuvant therapy was completed with acceptably few toxic effects but
with only a minor decrease in tumor size. Two patients underwent resection
and remained free of disease 20 and 22.5 months later. However, the median
survival of the entire neoadjuvant group was 8 months. All 24 patients with
potentially resectable carcinoma underwent surgical exploration. Fifteen of
the 24 patients underwent resection and survived a median of 12.5 months.
Neoadjuvant chemoradiation may have improved outcome and resectability for
two (12.5%) of 16 patients with unresectable pancreatic carcinoma, but more
effective therapy options must be developed to improve outcome.
