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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2006

01-02-2006

A Multi-Institutional Phase II Trial of Preoperative Full-Dose Gemcitabine and Concurrent Radiation for Patients With Potentially Resectable Pancreatic Carcinoma

Authors: Mark S. Talamonti, MD, William Small Jr., MD, Mary F. Mulcahy, MD, Jeffrey D. Wayne, MD, Vikram Attaluri, MD, Lisa M. Colletti, MD, Mark M. Zalupski, MD, John P. Hoffman, MD, Gary M. Freedman, MD, Timothy J. Kinsella, MD, Philip A. Philip, MD, Cornelius J. McGinn, MD

Published in: Annals of Surgical Oncology | Issue 2/2006

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Abstract

Background

We report the results of a multi-institutional phase II trial that used preoperative full-dose gemcitabine and radiotherapy for patients with potentially resectable pancreatic carcinoma.

Methods

Patients were treated before surgery with three cycles of full-dose gemcitabine (1000 mg/m2 intravenously), with radiation during the second cycle (36 Gy in daily 2.4-Gy fractions). Patients underwent surgery 4 to 6 weeks after the last gemcitabine infusion.

Results

There were 10 men and 10 women, with a median age of 58 years (range, 50–80 years). Nineteen patients (95%) completed therapy without interruption, and one experienced grade 3 gastrointestinal toxicity. The mean weight loss after therapy was 4.0%. Of 20 patients taken to surgery, 17 (85%) underwent resections (16 pancreaticoduodenectomies and 1 distal pancreatectomy). The complication rate was 24%, with an average length of stay of 13.5 days. There were no operative deaths. Pathologic analysis revealed clear margins in 16 (94%) of 17 and uninvolved lymph nodes in 11 (65%) of 17 specimens. One specimen contained no residual tumor, and three specimens revealed only microscopic foci of residual disease. With a median follow-up of 18 months, 7 (41%) of the 17 patients with resected disease are alive with no recurrence, 3 (18%) are alive with distant metastases, and 7 (41%) have died.

Conclusions

Preoperative gemcitabine/radiotherapy is well tolerated and safe when delivered in a multi-institutional setting. This protocol had a high rate of subsequent resection, with acceptable morbidity. The high rate of negative margins and uninvolved nodes suggests a significant tumor response. Preliminary survival data are encouraging. This regimen should be considered in future neoadjuvant trials for pancreatic cancer.
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Metadata
Title
A Multi-Institutional Phase II Trial of Preoperative Full-Dose Gemcitabine and Concurrent Radiation for Patients With Potentially Resectable Pancreatic Carcinoma
Authors
Mark S. Talamonti, MD
William Small Jr., MD
Mary F. Mulcahy, MD
Jeffrey D. Wayne, MD
Vikram Attaluri, MD
Lisa M. Colletti, MD
Mark M. Zalupski, MD
John P. Hoffman, MD
Gary M. Freedman, MD
Timothy J. Kinsella, MD
Philip A. Philip, MD
Cornelius J. McGinn, MD
Publication date
01-02-2006
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 2/2006
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/ASO.2006.03.039

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