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Published in: Journal of Gastrointestinal Surgery 9/2008

01-09-2008 | review article

Neoadjuvant Therapy for Pancreatic Cancer

Author: Andrew M. Lowy

Published in: Journal of Gastrointestinal Surgery | Issue 9/2008

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Abstract

Surgical resection is necessary but generally insufficient as curative treatment for pancreatic cancer. Traditionally, postoperative (adjuvant) therapies have been utilized in an attempt to improve outcome, yet these efforts have met with extremely limited success. As preoperative (neoadjuvant) treatment strategies have evolved for the treatment of other malignancies, preoperative therapy for pancreatic cancer has been investigated by several groups over the past decade. At this time, no randomized trials comparing adjuvant and neoadjuvant therapies have been performed, nor have there been any large multicenter trials of neoadjuvant therapy for pancreatic cancer. In this manuscript, the rationale for neoadjuvant strategies are discussed in the context of the available data on both adjuvant and neoadjuvant therapy and clinical trials currently in development.
Literature
2.
go back to reference Moertel CG, Frytak S, Hahn RG, Siegel R, Ward E, O’Connell MJ, Reitemeier RJ, Rubin J, Schutt AJ, Weiland LH, Childs DS, Holbrook MA, Lavin PT, Livstone E, Spiro H, Knwolton A, Kalser M, Barkin J, Lesssner H, Mann-Kaplan R, Ramming K, Douglas HO, Thomas P, Nave H, Bateman J, Lokich J, Brooks J, Chaffey J, Corson JM, Zamcheck N, Novak JW. Therapy of locally unresectable pancreatic carcinoma: A randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads +5-fluorouracil), and high dose radiation +5-fluorouracil: The Gastrointestinal Tumor Study Group. Cancer 1981;48:1705–1710.PubMedCrossRef Moertel CG, Frytak S, Hahn RG, Siegel R, Ward E, O’Connell MJ, Reitemeier RJ, Rubin J, Schutt AJ, Weiland LH, Childs DS, Holbrook MA, Lavin PT, Livstone E, Spiro H, Knwolton A, Kalser M, Barkin J, Lesssner H, Mann-Kaplan R, Ramming K, Douglas HO, Thomas P, Nave H, Bateman J, Lokich J, Brooks J, Chaffey J, Corson JM, Zamcheck N, Novak JW. Therapy of locally unresectable pancreatic carcinoma: A randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads +5-fluorouracil), and high dose radiation +5-fluorouracil: The Gastrointestinal Tumor Study Group. Cancer 1981;48:1705–1710.PubMedCrossRef
3.
go back to reference Kalser MH, Ellenberg SS. Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg 1985;120:899–903.PubMed Kalser MH, Ellenberg SS. Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg 1985;120:899–903.PubMed
4.
go back to reference Yeo CJ, Abrams RA, Grochow LB, Sohn TA, Ord SE, Hruban RH, Zahurak ML, Dooley WC, Coleman J, Sauter PK, Pitt HA, Lillemoe KD, Cameron JL. Pancreaticoduodenectomy for pancreatic adenocarcinoma: Postoperative adjuvant chemoradiation improves survival. A prospective, single-institution experience. Ann Surg 1997;225:621–633.PubMedCrossRef Yeo CJ, Abrams RA, Grochow LB, Sohn TA, Ord SE, Hruban RH, Zahurak ML, Dooley WC, Coleman J, Sauter PK, Pitt HA, Lillemoe KD, Cameron JL. Pancreaticoduodenectomy for pancreatic adenocarcinoma: Postoperative adjuvant chemoradiation improves survival. A prospective, single-institution experience. Ann Surg 1997;225:621–633.PubMedCrossRef
5.
go back to reference Klinkenbijl JH, Jeekel J, Sahmoud T, van Pel R, Couvreur ML, Veenhof CH, Arnaud JP, Gonzalez DG, de Wit LT, Hennipman A, Wils J. 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;230:776–782.PubMedCrossRef Klinkenbijl JH, Jeekel J, Sahmoud T, van Pel R, Couvreur ML, Veenhof CH, Arnaud JP, Gonzalez DG, de Wit LT, Hennipman A, Wils J. 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;230:776–782.PubMedCrossRef
6.
go back to reference Neoptolemos JP, Stocken DD, Friess H, Bassi C, Dunn JA, Hickey H, Beger H, Fernandez-Cruz L, Dervenis C, Lacaine F, Falconi M, Pederzoli P, Pap A, Spooner D, Kerr DJ, Büchler MW, European Study Group for Pancreatic Cancer. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004;350:1200–1210.PubMedCrossRef Neoptolemos JP, Stocken DD, Friess H, Bassi C, Dunn JA, Hickey H, Beger H, Fernandez-Cruz L, Dervenis C, Lacaine F, Falconi M, Pederzoli P, Pap A, Spooner D, Kerr DJ, Büchler MW, European Study Group for Pancreatic Cancer. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004;350:1200–1210.PubMedCrossRef
7.
go back to reference Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K, Schramm H, Fahlke J, Zuelke C, Burkart C, Gutberlet K, Kettner E, Schmalenberg H, Weigang-Koehler K, Bechstein WO, Niedergethmann M, Schmidt-Wolf I, Roll L, Doerken B, Riess H. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: A randomized controlled trial. JAMA 2007;297:267–277.PubMedCrossRef Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K, Schramm H, Fahlke J, Zuelke C, Burkart C, Gutberlet K, Kettner E, Schmalenberg H, Weigang-Koehler K, Bechstein WO, Niedergethmann M, Schmidt-Wolf I, Roll L, Doerken B, Riess H. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: A randomized controlled trial. JAMA 2007;297:267–277.PubMedCrossRef
8.
go back to reference Regine WF, Winter KW, Abrams R. RTOG 9704, a phase III study of adjuvant pre and post chemoradiation (CRT) 5-FU vs. Gemcitabine for resected pancreatic adenocarcinoma (abstract 407). J Clin Oncol 2006;24:180s. Regine WF, Winter KW, Abrams R. RTOG 9704, a phase III study of adjuvant pre and post chemoradiation (CRT) 5-FU vs. Gemcitabine for resected pancreatic adenocarcinoma (abstract 407). J Clin Oncol 2006;24:180s.
9.
go back to reference Bilimoria KY, Bentrem DJ, Ko CY, Tomlinson JS, Stewart AK, Winchester DP, Talamonti MS. Multimodality therapy for pancreatic cancer in the U.S.: Utilization, outcomes, and the effect of hospital volume. Cancer 2007;110:1227–1234.PubMedCrossRef Bilimoria KY, Bentrem DJ, Ko CY, Tomlinson JS, Stewart AK, Winchester DP, Talamonti MS. Multimodality therapy for pancreatic cancer in the U.S.: Utilization, outcomes, and the effect of hospital volume. Cancer 2007;110:1227–1234.PubMedCrossRef
10.
go back to reference Yeung RS, Weese JL, Hoffman JP, Solin LJ, Paul AR, Engstrom PF, Litwin S, Kowalyshyn MJ, Eisenberg BL. Neoadjuvant chemoradiation in pancreatic and duodenal carcinoma. A Phase II Study. Cancer 1993;72:2124–2133.PubMedCrossRef Yeung RS, Weese JL, Hoffman JP, Solin LJ, Paul AR, Engstrom PF, Litwin S, Kowalyshyn MJ, Eisenberg BL. Neoadjuvant chemoradiation in pancreatic and duodenal carcinoma. A Phase II Study. Cancer 1993;72:2124–2133.PubMedCrossRef
11.
go back to reference Staley CA, Lee JE, Cleary KA, Abbruzzese JL, Fenoglio CJ, Rich TA, Evans DB. Preoperative chemoradiation, pancreaticoduodenectomy, and intraoperative radiation therapy for adenocarcinoma of the pancreatic head. Am J Surg 1996;171:118–124.PubMedCrossRef Staley CA, Lee JE, Cleary KA, Abbruzzese JL, Fenoglio CJ, Rich TA, Evans DB. Preoperative chemoradiation, pancreaticoduodenectomy, and intraoperative radiation therapy for adenocarcinoma of the pancreatic head. Am J Surg 1996;171:118–124.PubMedCrossRef
12.
go back to reference Spitz FR, Abbruzzese JL, Lee JE, Pisters PW, Lowy AM, Fenoglio CJ, Cleary KR, Janjan NA, Goswitz MS, Rich TA, Evans DB. Preoperative and postoperative chemoradiation strategies in patients treated with pancreaticoduodenectomy for adenocarcinoma of the pancreas. J Clin Oncol 1997;15:928–937.PubMed Spitz FR, Abbruzzese JL, Lee JE, Pisters PW, Lowy AM, Fenoglio CJ, Cleary KR, Janjan NA, Goswitz MS, Rich TA, Evans DB. Preoperative and postoperative chemoradiation strategies in patients treated with pancreaticoduodenectomy for adenocarcinoma of the pancreas. J Clin Oncol 1997;15:928–937.PubMed
13.
go back to reference White R, Hurwitz H, Lee C, Morse M, Anscher M, Paulson E, Gotfried M, Baillie J, Branch M, Jowell P, McGrath K, Clary B, Pappas T, Tyler DS. Neoadjuvant chemoradiation for localized adenocarcinoma of the pancreas. Ann Surg Oncol 2001;8:758–765.PubMedCrossRef White R, Hurwitz H, Lee C, Morse M, Anscher M, Paulson E, Gotfried M, Baillie J, Branch M, Jowell P, McGrath K, Clary B, Pappas T, Tyler DS. Neoadjuvant chemoradiation for localized adenocarcinoma of the pancreas. Ann Surg Oncol 2001;8:758–765.PubMedCrossRef
14.
go back to reference Pisters PW, Wolff RA, Janjan NA, Cleary KR, Charnsangavej C, Crane CN, Lenzi R, Vauthey JN, Lee JE, Abbruzzese JL, Evans DB. Preoperative paclitaxel and concurrent rapid-fractionation radiation for resectable pancreatic adenocarcinoma: toxicities, histologic response rates, and event-free outcome. J Clin Oncol 2002;20:2537.PubMedCrossRef Pisters PW, Wolff RA, Janjan NA, Cleary KR, Charnsangavej C, Crane CN, Lenzi R, Vauthey JN, Lee JE, Abbruzzese JL, Evans DB. Preoperative paclitaxel and concurrent rapid-fractionation radiation for resectable pancreatic adenocarcinoma: toxicities, histologic response rates, and event-free outcome. J Clin Oncol 2002;20:2537.PubMedCrossRef
15.
go back to reference Wolff RA, Evans DB, Crane CH. Initial results of preoperative gemcitabine-based chemoradiation for resectable pancreatic adenocarcinoma (abstract). Proc Am Soc Clin Oncol 2002;21:130. Wolff RA, Evans DB, Crane CH. Initial results of preoperative gemcitabine-based chemoradiation for resectable pancreatic adenocarcinoma (abstract). Proc Am Soc Clin Oncol 2002;21:130.
16.
go back to reference Talamonti MS, Small W Jr, Mulcahy MF, Wayne JD, Attaluri V, Colletti LM, Zalupski MM, Hoffman JP, Freedman GM, Kinsella TJ, Philip PA, McGinn CJ. A multi-institutional phase II trial of preoperative full-dose gemcitabine and concurrent radiation for patients with potentially resectable pancreatic carcinoma. Ann Surg Oncol 2006;13:150–158.PubMedCrossRef Talamonti MS, Small W Jr, Mulcahy MF, Wayne JD, Attaluri V, Colletti LM, Zalupski MM, Hoffman JP, Freedman GM, Kinsella TJ, Philip PA, McGinn CJ. A multi-institutional phase II trial of preoperative full-dose gemcitabine and concurrent radiation for patients with potentially resectable pancreatic carcinoma. Ann Surg Oncol 2006;13:150–158.PubMedCrossRef
18.
go back to reference Varadhachary GR, Tamm EP, Abbruzzese JL, Xiong HQ, Crane CH, Wang H, Lee JE, Pisters PW, Evans DB, Wolff RA. Ann Surg Oncol 2006;13:1035–1046.PubMedCrossRef Varadhachary GR, Tamm EP, Abbruzzese JL, Xiong HQ, Crane CH, Wang H, Lee JE, Pisters PW, Evans DB, Wolff RA. Ann Surg Oncol 2006;13:1035–1046.PubMedCrossRef
19.
go back to reference Snady H, Bruckner H, Cooperman A, Paradiso J, Kiefer L. Survival advantage of combined chemoradiotherapy compared with resection as the initial treatment of patients with regional pancreatic carcinoma. An outcomes trial. Cancer 2000;89:314–27.PubMedCrossRef Snady H, Bruckner H, Cooperman A, Paradiso J, Kiefer L. Survival advantage of combined chemoradiotherapy compared with resection as the initial treatment of patients with regional pancreatic carcinoma. An outcomes trial. Cancer 2000;89:314–27.PubMedCrossRef
20.
go back to reference Kim HJ, Czischke K, Brennan MF, Conlon KC. Does neoadjuvant chemoradiation downstage locally advanced pancreatic cancer. J Gastrointest Surg 2002;6:763–769.PubMedCrossRef Kim HJ, Czischke K, Brennan MF, Conlon KC. Does neoadjuvant chemoradiation downstage locally advanced pancreatic cancer. J Gastrointest Surg 2002;6:763–769.PubMedCrossRef
21.
go back to reference White RR, Tyler DS. Neoadjuvant therapy for pancreatic cancer: The Duke experience. Surg Oncol Clin N Am 2004;13:675–684.PubMedCrossRef White RR, Tyler DS. Neoadjuvant therapy for pancreatic cancer: The Duke experience. Surg Oncol Clin N Am 2004;13:675–684.PubMedCrossRef
22.
go back to reference Isacoff WH, Bendetti JK, Barstis JJ, Jazieh AR, Macdonald JS, Philip PA. Phase II trial of infusional fluorouracil, leucovorin, mitomycin, and dipyridamole in locally advanced unresectable pancreatic adenocarcinoma: SWOG S9700. J Clin Oncol 2007;25:1665–1669.PubMedCrossRef Isacoff WH, Bendetti JK, Barstis JJ, Jazieh AR, Macdonald JS, Philip PA. Phase II trial of infusional fluorouracil, leucovorin, mitomycin, and dipyridamole in locally advanced unresectable pancreatic adenocarcinoma: SWOG S9700. J Clin Oncol 2007;25:1665–1669.PubMedCrossRef
23.
go back to reference Pipas JM, Barth RJ Jr, Zaki B, Tsapakos MJ, Suriawinata AA, Bettmann MA, Cates JM, Ripple GH, Sutton JE, Gordon SR, McDonnell CE, Perez RP, Redfield N, Meyer LP, Marshall JF, Cole BF, Colacchio TA. Docetaxel/Gemcitabine followed by gemcitabine and external beam radiotherapy in patients with pancreatic adenocarcinoma. Ann Surg Oncol 2005;12:995–1004.PubMedCrossRef Pipas JM, Barth RJ Jr, Zaki B, Tsapakos MJ, Suriawinata AA, Bettmann MA, Cates JM, Ripple GH, Sutton JE, Gordon SR, McDonnell CE, Perez RP, Redfield N, Meyer LP, Marshall JF, Cole BF, Colacchio TA. Docetaxel/Gemcitabine followed by gemcitabine and external beam radiotherapy in patients with pancreatic adenocarcinoma. Ann Surg Oncol 2005;12:995–1004.PubMedCrossRef
24.
go back to reference Massucco P, Capussotti L, Magnino A, Sperti E, Gatti M, Muratore A, Sgotto E, Gabriele P, Aglietta M. Pancreatic resections after chemoradiotherapy for locally advanced ductal adenocarcinoma: Analysis of perioperative outcome and survival. Ann Surg Oncol. 2006;13:1201–1208.PubMedCrossRef Massucco P, Capussotti L, Magnino A, Sperti E, Gatti M, Muratore A, Sgotto E, Gabriele P, Aglietta M. Pancreatic resections after chemoradiotherapy for locally advanced ductal adenocarcinoma: Analysis of perioperative outcome and survival. Ann Surg Oncol. 2006;13:1201–1208.PubMedCrossRef
25.
go back to reference Brunner TB, Grabenbauer GG, Meyer T, Golcher H, Sauer R, Hohenberger W. Primary resection versus neoadjuvant chemoradiation followed by resection for locally resectable or potentially resectable pancreatic carcinoma without distant metastasis. A multi-centre prospectively randomised phase II-study of the Interdisciplinary Working Group Gastrointestinal Tumours (AIO, ARO, and CAO). BMC Cancer 2007;6:41–45.CrossRef Brunner TB, Grabenbauer GG, Meyer T, Golcher H, Sauer R, Hohenberger W. Primary resection versus neoadjuvant chemoradiation followed by resection for locally resectable or potentially resectable pancreatic carcinoma without distant metastasis. A multi-centre prospectively randomised phase II-study of the Interdisciplinary Working Group Gastrointestinal Tumours (AIO, ARO, and CAO). BMC Cancer 2007;6:41–45.CrossRef
26.
go back to reference Crane CH, Ellis LM, Abbruzzese JL, Amos C, Xiong HQ, Ho L, Evans DB, Tamm EP, Ng C, Pisters PW, Charnsangavej C, Delclos ME, O'Reilly M, Lee JE, Wolff RA. Phase I trial evaluating the safety of bevacizumab with concurrent radiotherapy and capecitabine in locally advanced pancreatic cancer. J Clin Oncol. 2006;24:1145–1151.PubMedCrossRef Crane CH, Ellis LM, Abbruzzese JL, Amos C, Xiong HQ, Ho L, Evans DB, Tamm EP, Ng C, Pisters PW, Charnsangavej C, Delclos ME, O'Reilly M, Lee JE, Wolff RA. Phase I trial evaluating the safety of bevacizumab with concurrent radiotherapy and capecitabine in locally advanced pancreatic cancer. J Clin Oncol. 2006;24:1145–1151.PubMedCrossRef
27.
go back to reference Duffy A, Kortmansky J, Schwartz GK, Capanu M, Puleio S, Minsky B, Saltz L, Kelsen DP, O'reilly EM. A phase I study of erlotinib in combination with gemcitabine and radiation in locally advanced, non-operable pancreatic adenocarcinoma. Ann Oncol 2008;19:86–91.PubMedCrossRef Duffy A, Kortmansky J, Schwartz GK, Capanu M, Puleio S, Minsky B, Saltz L, Kelsen DP, O'reilly EM. A phase I study of erlotinib in combination with gemcitabine and radiation in locally advanced, non-operable pancreatic adenocarcinoma. Ann Oncol 2008;19:86–91.PubMedCrossRef
28.
go back to reference White R, Xie B, Gotfried M, Hurwitz H, Morse M, Blobe G, Czito B, Paulson E, Baillie J, Branch M, Jowell P, Clary B, Pappas T, Tyler DS. Prognostic significance of histologic response to preoperative chemoradiation of periampullary malignancies. Ann Surg Oncol. 2005;12:214–221.PubMedCrossRef White R, Xie B, Gotfried M, Hurwitz H, Morse M, Blobe G, Czito B, Paulson E, Baillie J, Branch M, Jowell P, Clary B, Pappas T, Tyler DS. Prognostic significance of histologic response to preoperative chemoradiation of periampullary malignancies. Ann Surg Oncol. 2005;12:214–221.PubMedCrossRef
29.
go back to reference Hoffman JP, Lipsitz S, Pisansky T, Weese JL, Solin L, Benson AB 3rd. Phase II trial of preoperative radiation therapy and chemotherapy for patients with localized, resectable adenocarcinoma of the pancreas: An Eastern Cooperative Oncology Group Study. J Clin Oncol 1998;16:317–323.PubMed Hoffman JP, Lipsitz S, Pisansky T, Weese JL, Solin L, Benson AB 3rd. Phase II trial of preoperative radiation therapy and chemotherapy for patients with localized, resectable adenocarcinoma of the pancreas: An Eastern Cooperative Oncology Group Study. J Clin Oncol 1998;16:317–323.PubMed
30.
go back to reference Pisters PW, Abbruzzese JL, Janjan NA, Cleary KR, Charnsangavej C, Goswitz MS, Rich TA, Raijman I, Wolff RA, Lenzi R, Lee JE, Evans DB. Rapid-fractionation preoperative chemoradiation, pancreaticoduodenectomy, and intraoperative radiation therapy for resectable pancreatic adenocarcinoma. J Clin Oncol 1998;16:3843.PubMed Pisters PW, Abbruzzese JL, Janjan NA, Cleary KR, Charnsangavej C, Goswitz MS, Rich TA, Raijman I, Wolff RA, Lenzi R, Lee JE, Evans DB. Rapid-fractionation preoperative chemoradiation, pancreaticoduodenectomy, and intraoperative radiation therapy for resectable pancreatic adenocarcinoma. J Clin Oncol 1998;16:3843.PubMed
31.
go back to reference Meszoely IM, Wang H, Hoffman JP. Preoperative chemoradiation therapy for adenocarcinoma of the pancreas: The Fox Chase Cancer Center experience, 1986–2003. Surg Oncol Clin N Am 2004;13:685–696.PubMedCrossRef Meszoely IM, Wang H, Hoffman JP. Preoperative chemoradiation therapy for adenocarcinoma of the pancreas: The Fox Chase Cancer Center experience, 1986–2003. Surg Oncol Clin N Am 2004;13:685–696.PubMedCrossRef
32.
go back to reference Moutardier V, Magnin V, Turrini O, Viret F, Hennekinne-Mucci S, Gonçalves A, Pesenti C, Guiramand J, Lelong B, Giovannini M, Monges G, Houvenaeghel G, Delpero JR. Assessment of pathologic response after preoperative chemoradiotherapy and surgery in pancreatic adenocarcinoma. Int J Radiat Oncol Biol Phys 2004;60:437.PubMed Moutardier V, Magnin V, Turrini O, Viret F, Hennekinne-Mucci S, Gonçalves A, Pesenti C, Guiramand J, Lelong B, Giovannini M, Monges G, Houvenaeghel G, Delpero JR. Assessment of pathologic response after preoperative chemoradiotherapy and surgery in pancreatic adenocarcinoma. Int J Radiat Oncol Biol Phys 2004;60:437.PubMed
33.
go back to reference Mornex F, Girard N, Delpero JR, Partensky C. Radiochemotherapy in the management of pancreatic cancer—Part I: neoadjuvant treatment. Semin Radiat Oncol 2005;15:226–234.PubMedCrossRef Mornex F, Girard N, Delpero JR, Partensky C. Radiochemotherapy in the management of pancreatic cancer—Part I: neoadjuvant treatment. Semin Radiat Oncol 2005;15:226–234.PubMedCrossRef
34.
go back to reference Kamthan AG, Morris JC, Dalton J, Mandeli JP, Chesser MR, Leben D, Cooperman A, Bruckner HW. Combined modality therapy for stage II and stage III pancreatic carcinoma. J Clin Oncol 1997;15:2920–2927.PubMed Kamthan AG, Morris JC, Dalton J, Mandeli JP, Chesser MR, Leben D, Cooperman A, Bruckner HW. Combined modality therapy for stage II and stage III pancreatic carcinoma. J Clin Oncol 1997;15:2920–2927.PubMed
35.
go back to reference Ammori JB, Colletti LM, Zalupski MM, Eckhauser FE, Greenson JK, Dimick J, Lawrence TS, McGinn CJ. Surgical resection following radiation therapy with concurrent gemcitabine in patients with previously unresectable adenocarcinoma of the pancreas. J Gastrointest Surg 2003;7:766–772.PubMedCrossRef Ammori JB, Colletti LM, Zalupski MM, Eckhauser FE, Greenson JK, Dimick J, Lawrence TS, McGinn CJ. Surgical resection following radiation therapy with concurrent gemcitabine in patients with previously unresectable adenocarcinoma of the pancreas. J Gastrointest Surg 2003;7:766–772.PubMedCrossRef
36.
go back to reference Aristu J, Canon R, Pardo F, Martínez-Monge R, Martin-Algarra S, Manuel Ordoñez J, Villafranca E, Moreno M, Cambeiro M, Azinovic I. Surgical resection after preoperative chemoradiotherapy benefits selected patients with unresectable pancreatic cancer. Am J Clin Oncol 2003;26:30–36.PubMedCrossRef Aristu J, Canon R, Pardo F, Martínez-Monge R, Martin-Algarra S, Manuel Ordoñez J, Villafranca E, Moreno M, Cambeiro M, Azinovic I. Surgical resection after preoperative chemoradiotherapy benefits selected patients with unresectable pancreatic cancer. Am J Clin Oncol 2003;26:30–36.PubMedCrossRef
37.
go back to reference Joensuu TK, Kiviluoto T, Kärkkäinen P, Vento P, Kivisaari L, Tenhunen M, Westberg R, Elomaa I. Phase I–II trial of twice-weekly gemcitabine and concomitant irradiation in patients undergoing pancreaticoduodenectomy with extended lymphadenectomy for locally advanced pancreatic cancer. Rad Oncol 2004;60:444–452. Joensuu TK, Kiviluoto T, Kärkkäinen P, Vento P, Kivisaari L, Tenhunen M, Westberg R, Elomaa I. Phase I–II trial of twice-weekly gemcitabine and concomitant irradiation in patients undergoing pancreaticoduodenectomy with extended lymphadenectomy for locally advanced pancreatic cancer. Rad Oncol 2004;60:444–452.
Metadata
Title
Neoadjuvant Therapy for Pancreatic Cancer
Author
Andrew M. Lowy
Publication date
01-09-2008
Publisher
Springer-Verlag
Published in
Journal of Gastrointestinal Surgery / Issue 9/2008
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-008-0482-2

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