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Journal of Hepato-Biliary-Pancreatic Sciences

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01-02-2013 | Original article

Pathological and clinical impact of neoadjuvant chemoradiotherapy using full-dose gemcitabine and concurrent radiation for resectable pancreatic cancer

Authors: Masayuki Sho, Takahiro Akahori, Toshihiro Tanaka, Shoichi Kinoshita, Tetsuro Tamamoto, Takeo Nomi, Ichiro Yamato, Daisuke Hokuto, Satoshi Yasuda, Chihiro Kawaguchi, Hideyuki Nishiofuku, Nagaaki Marugami, Yasunori Enomonoto, Takahiko Kasai, Masatoshi Hasegawa, Kimihiko Kichikawa, Yoshiyuki Nakajima

Published in: Journal of Hepato-Biliary-Pancreatic Sciences | Issue 2/2013

Abstract

Background/purpose

The therapeutic options available as preoperative strategies for resectable pancreatic cancer have received worldwide attention. We have recently introduced neoadjuvant chemoradiotherapy (NACRT) to achieve local control and possibly complete cure. In this study, we have retrospectively evaluated its impact on pathology and the perioperative clinical course in addition to its safety.

Methods

Sixty-one patients who received full-dose gemcitabine (1000 mg/m²) preoperatively with concurrent radiation (50 or 54 Gy) were evaluated. Seventy-one patients who received no preoperative therapy served as controls. Perioperative outcomes, postoperative complications, immunonutritional status, and the performance of adjuvant chemotherapy were compared.

Results

Fifty-nine patients (97 %) completed NACRT. Toxicity was acceptable and the regimen was feasible as outpatient treatment. The perioperative outcomes were closely comparable to control. The rate of pancreatic fistula was lower and hospital stay was shorter in the NACRT group. The rate of lymph node metastasis and stage was lower in the NACRT group. Furthermore, R0 resection could be achieved in 92 % of patients treated with NACRT. Nutritional status decreased after NACRT and further deteriorated during adjuvant chemotherapy. The initiation of postoperative chemotherapy was delayed in the NACRT group.

Conclusions

Our current protocol of neoadjuvant chemoradiotherapy is feasible and substantially improves the pathology. However, it has some detrimental effects on postoperative nutritional status and performance of adjuvant chemotherapy. Furthermore, it should be noted that there is a possibility of arterial complications.

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Title: Pathological and clinical impact of neoadjuvant chemoradiotherapy using full-dose gemcitabine and concurrent radiation for resectable pancreatic cancer
Authors: Masayuki Sho
Takahiro Akahori
Toshihiro Tanaka
Shoichi Kinoshita
Tetsuro Tamamoto
Takeo Nomi
Ichiro Yamato
Daisuke Hokuto
Satoshi Yasuda
Chihiro Kawaguchi
Hideyuki Nishiofuku
Nagaaki Marugami
Yasunori Enomonoto
Takahiko Kasai
Masatoshi Hasegawa
Kimihiko Kichikawa
Yoshiyuki Nakajima
Publication date: 01-02-2013
Publisher: Springer Japan
Published in: Journal of Hepato-Biliary-Pancreatic Sciences / Issue 2/2013
Print ISSN: 1868-6974
Electronic ISSN: 1868-6982
DOI: https://doi.org/10.1007/s00534-012-0532-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pathological and clinical impact of neoadjuvant chemoradiotherapy using full-dose gemcitabine and concurrent radiation for resectable pancreatic cancer

Abstract

Background/purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background/purpose

Methods

Results

Conclusions

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