Source: DGNews  |  Posted 2 years ago

By Wayne Kuznar

PHOENIX, Ariz -- March 8, 2009 -- Neoadjuvant therapy of patients with borderline resectable pancreatic adenocarcinoma may help change the disease stage and might help identify patients who are likely to benefit from pancreatic resection, according to data presented here at the Society of Surgical Oncology (SSO) 62nd Annual Cancer Symposium.

Almost half of patients with borderline resectable pancreatic adenocarcinoma were able to undergo pancreatic resection following chemoradiation, reported lead author Jayme B. Stokes, MD, University of Virginia, Charlottesville, Virginia, speaking at a poster session here on March 7.

“This is a subset of patients who would not otherwise be able to undergo resection; however, we found that if you treat them preoperatively with radiation and chemotherapy, half of those patients could then go on to pancreatic resection with a survival benefit that comes along with resection of the cancer,” said Dr. Stokes.

Patients with resectable pancreatic cancer may experience median survival in excess of 2 years after multidisciplinary therapy including surgery, the research team noted. Patients with locally advanced disease, however, are currently not candidates for resection, and their median survival is less than 12 months.

Dr. Stokes and colleagues identified 170 patients undergoing evaluation for pancreatic adenocarcinoma at the Surgical Oncology Clinic of the University of Virginia between August 2005 and August 2008. Patients were staged as potentially resectable (n = 74), unresectable (n = 55), or borderline resectable (n = 41) using the M. D. Anderson Cancer Center (MDACC) Multidisciplinary Pancreatic Cancer Study Group classification.

Thirty-five patients classified as borderline resectable completed neoadjuvant therapy and were restaged. Twelve patients were restaged as unresectable due to local progression or distant metastases, and 23 were reclassified as potentially resectable. Of the 23 reclassified as potentially resectable, 7 had either distant metastases or local invasion discovered and were not resected.

Pancreatic resection was performed in 16 (46%) of the original 35 patients classified as borderline resectable who completed neoadjuvant therapy. Fifteen patients who underwent resection received capecitabine-based neoadjuvant therapy and 1 received gemcitabine. Seven patients completed 50 Gy of radiation in 28 fractions over 6 weeks, 8 were treated with 50 Gy in 20 fractions over 4 weeks, and 1 patient did not complete radiation.

“Patients who got equivalent [radiation] doses in a shortened timeframe tend to have a better response pathologically,” said Dr. Stokes; a greater than 90% pathologic response was significantly more likely (P < .05) with treatment with 50 Gy of radiation in 20 fractions versus 28 doses.

Of the 16 patients undergoing pancreatic resection, 12 had vascular involvement (MDACC group A), 1 had questionable metastatic disease (MDACC group B), and 3 had marginal performance status (MDACC group C).

[Presentation title: Outcome Following Neoadjuvant Therapy for Borderline Resectable Pancreatic Cancer. Abstract P171]