Skip to main content
Top
Published in: Annals of Surgical Oncology 7/2009

01-07-2009 | CONSENSUS REPORT: RESECTABLE AND BORDERLINE RESECTABLE PANCREAS CANCER

Combined Modality Treatment of Resectable and Borderline Resectable Pancreas Cancer: Expert Consensus Statement

Authors: Ross A. Abrams, MD, Andrew M. Lowy, MD, Eileen M. O’Reilly, MD, Robert A. Wolff, MD, Vincent J. Picozzi, MD, MMM, Peter W. T. Pisters, MD

Published in: Annals of Surgical Oncology | Issue 7/2009

Login to get access

Excerpt

This year approximately 5000 patients in the United States will undergo resection of pancreatic cancer with curative intent. Despite concerted international efforts, especially over the past 20 years, survival statistics for such patients have changed little and remain disappointing. Reported 2- and-5 year overall survival rates for patient with resected pancreas cancer are 40–50% and 15–20%, respectively, and rates of local and systemic recurrence also remain high—35–60% and 80–90%, respectively.17 Considerable debate surrounds the best therapeutic approach for such patients. …
Literature
1.
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
2.
go back to reference Neoptolemos JP, Stocken DD, Friess H, Bassi C, Dunn JA, Hickey H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med. 2004;350:1200–10.PubMedCrossRef Neoptolemos JP, Stocken DD, Friess H, Bassi C, Dunn JA, Hickey H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med. 2004;350:1200–10.PubMedCrossRef
3.
go back to reference Klinkenbijl JH, Jeekel J, Sahmoud T, van Pel R, Couvreur ML, Veenhof CH, et al. 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;230:776–82;discussion 82–4.PubMedCrossRef Klinkenbijl JH, Jeekel J, Sahmoud T, van Pel R, Couvreur ML, Veenhof CH, et al. 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;230:776–82;discussion 82–4.PubMedCrossRef
4.
go back to reference Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA. 2007;297:267–77.PubMedCrossRef Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA. 2007;297:267–77.PubMedCrossRef
5.
go back to reference Regine WF, Winter KA, Abrams RA, Safran H, Hoffman JP, Konski A, et al. Fluorouracil vs gemcitabine chemotherapy before and after fluorouracil-based chemoradiation following resection of pancreatic adenocarcinoma: a randomized controlled trial. JAMA. 2008;299:1019–26.PubMedCrossRef Regine WF, Winter KA, Abrams RA, Safran H, Hoffman JP, Konski A, et al. Fluorouracil vs gemcitabine chemotherapy before and after fluorouracil-based chemoradiation following resection of pancreatic adenocarcinoma: a randomized controlled trial. JAMA. 2008;299:1019–26.PubMedCrossRef
6.
go back to reference Griffin JF, Smalley SR, Jewell W, Paradelo JC, Reymond RD, Hassanein RE, et al. Patterns of failure after curative resection of pancreatic adenocarcinomas. Cancer. 1990;66:56–61.PubMedCrossRef Griffin JF, Smalley SR, Jewell W, Paradelo JC, Reymond RD, Hassanein RE, et al. Patterns of failure after curative resection of pancreatic adenocarcinomas. Cancer. 1990;66:56–61.PubMedCrossRef
7.
go back to reference Tepper J, Nardi G, Suit H. Carcinoma of the pancreas: Review of MGH experience from 1963–1973—Analysis of surgical failure and its implications for radiation therapy. Cancer. 1976;37:1519–24.PubMedCrossRef Tepper J, Nardi G, Suit H. Carcinoma of the pancreas: Review of MGH experience from 1963–1973—Analysis of surgical failure and its implications for radiation therapy. Cancer. 1976;37:1519–24.PubMedCrossRef
8.
go back to reference Evans DB, Rich TA, Byrd DR, Cleary KR, Connelly JH, Levin B, et al. Preoperative chemoradiation and pancreaticoduodenectomy for adenocarcinoma of the pancreas. Arch Surg. 1992;127:1335–9.PubMed Evans DB, Rich TA, Byrd DR, Cleary KR, Connelly JH, Levin B, et al. Preoperative chemoradiation and pancreaticoduodenectomy for adenocarcinoma of the pancreas. Arch Surg. 1992;127:1335–9.PubMed
9.
go back to reference Pisters PW, Abbruzzese JL, Janjan NA, Cleary KR, Charnsangavej C, Goswitz MS, et al. Rapid-fractionation preoperative chemoradiation, pancreaticoduodenectomy, and intraoperative radiation therapy for resectable pancreatic adenocarcinoma. J Clin Oncol. 1998;16:3843–50.PubMed Pisters PW, Abbruzzese JL, Janjan NA, Cleary KR, Charnsangavej C, Goswitz MS, et al. Rapid-fractionation preoperative chemoradiation, pancreaticoduodenectomy, and intraoperative radiation therapy for resectable pancreatic adenocarcinoma. J Clin Oncol. 1998;16:3843–50.PubMed
10.
go back to reference Evans DB, Varadhachary GR, Crane CH, Sun CC, Lee JE, Pisters PW, et al. Preoperative gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008;26:3496–502.PubMedCrossRef Evans DB, Varadhachary GR, Crane CH, Sun CC, Lee JE, Pisters PW, et al. Preoperative gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008;26:3496–502.PubMedCrossRef
11.
go back to reference Varadhachary GR, Wolff RA, Crane CH, Sun CC, Lee JE, Pisters PW, et al. Preoperative gemcitabine and cisplatin followed by gemcitabine-based chemoradiation for resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008; 26:3487–95.PubMedCrossRef Varadhachary GR, Wolff RA, Crane CH, Sun CC, Lee JE, Pisters PW, et al. Preoperative gemcitabine and cisplatin followed by gemcitabine-based chemoradiation for resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008; 26:3487–95.PubMedCrossRef
12.
go back to reference Smeenk HG, van Eijck CH, Hop WC, Erdmann J, Tran KC, Debois M, et al. Long-term survival and metastatic pattern of pancreatic and periampullary cancer after adjuvant chemoradiation or observation: long-term results of EORTC trial 40891. Ann Surg. 2007;246:734–40.PubMedCrossRef Smeenk HG, van Eijck CH, Hop WC, Erdmann J, Tran KC, Debois M, et al. Long-term survival and metastatic pattern of pancreatic and periampullary cancer after adjuvant chemoradiation or observation: long-term results of EORTC trial 40891. Ann Surg. 2007;246:734–40.PubMedCrossRef
13.
go back to reference Neoptolemos JP, Dunn JA, Stocken DD, Almond J, Link K, Beger H, et al. Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomised controlled trial. Lancet. 2001;358:1576–85.PubMedCrossRef Neoptolemos JP, Dunn JA, Stocken DD, Almond J, Link K, Beger H, et al. Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomised controlled trial. Lancet. 2001;358:1576–85.PubMedCrossRef
14.
go back to reference Abrams RA, Grochow LB. Adjuvant therapy with chemotherapy and radiation therapy in the management of carcinoma of the pancreatic head. Surg Clin North Am. 1995;75:925–38.PubMed Abrams RA, Grochow LB. Adjuvant therapy with chemotherapy and radiation therapy in the management of carcinoma of the pancreatic head. Surg Clin North Am. 1995;75:925–38.PubMed
15.
go back to reference Hsu CC, Herman JM, Corsini MM, et al. Benefit of adjuvant chemoradiation therapy for pancreatic adenocarcinoma: The Johns Hopkins Hospital-Mayo clinic collaborative study of 1,045 patients. J Clin Oncol. 2008;26:3503–10.PubMedCrossRef Hsu CC, Herman JM, Corsini MM, et al. Benefit of adjuvant chemoradiation therapy for pancreatic adenocarcinoma: The Johns Hopkins Hospital-Mayo clinic collaborative study of 1,045 patients. J Clin Oncol. 2008;26:3503–10.PubMedCrossRef
16.
go back to reference Corsini MM, Miller RC, Haddock MG, Donohue JH, Farnell MB, Nagorney DM, et al. Adjuvant radiotherapy and chemotherapy for pancreatic carcinoma. The Mayo Clinic Experience (1975–2005). J Clin Oncol. 2008;26:3511–6. Corsini MM, Miller RC, Haddock MG, Donohue JH, Farnell MB, Nagorney DM, et al. Adjuvant radiotherapy and chemotherapy for pancreatic carcinoma. The Mayo Clinic Experience (1975–2005). J Clin Oncol. 2008;26:3511–6.
17.
go back to reference Picozzi VJ, Abrams RA, Traverso LW, O’Reilly EM, Greeno E, Martin R, et al. ACOSOG Z05031: Initial report of a multicenter, phase II trial of novel chemoradiation protocol using cisplatin, 5-FU, and alpha-interferon as adjuvant therapy for resected pancreas cancer. J Clin Oncol. 2008 Annual Meeting Proceedings (May Supplement), 125. Picozzi VJ, Abrams RA, Traverso LW, O’Reilly EM, Greeno E, Martin R, et al. ACOSOG Z05031: Initial report of a multicenter, phase II trial of novel chemoradiation protocol using cisplatin, 5-FU, and alpha-interferon as adjuvant therapy for resected pancreas cancer. J Clin Oncol. 2008 Annual Meeting Proceedings (May Supplement), 125.
18.
go back to reference Bakkevold KE, Arnesjo B, Dahl O, Kambestad B. Adjuvant combination chemotherapy (AMF) following radical resection of carcinoma of the pancreas and papilla of Vater–results of a controlled, prospective, randomised multicentre study. Eur J Cancer. 1993;29A:698–703.PubMedCrossRef Bakkevold KE, Arnesjo B, Dahl O, Kambestad B. Adjuvant combination chemotherapy (AMF) following radical resection of carcinoma of the pancreas and papilla of Vater–results of a controlled, prospective, randomised multicentre study. Eur J Cancer. 1993;29A:698–703.PubMedCrossRef
19.
go back to reference Berger A, Winter KA, Hoffman JP, et al. Post-resection CA 19-9 predicts overall survival (OS) in patients treated with adjuvant chemoradiation: A secondary endpoint of RTOG 9704. J Clin Oncol. 2007 Annual Meeting Proceedings Part 1, Vol 25, No. 18S (June Supplement), 207:4522. Berger A, Winter KA, Hoffman JP, et al. Post-resection CA 19-9 predicts overall survival (OS) in patients treated with adjuvant chemoradiation: A secondary endpoint of RTOG 9704. J Clin Oncol. 2007 Annual Meeting Proceedings Part 1, Vol 25, No. 18S (June Supplement), 207:4522.
20.
go back to reference Abrams RA, Winter KA, Regine WF, Safran H, Hoffman JP, Konski AA, et al. RTOG 97-04—Radiotherapy Quality Assurance (QA) Review and Survival. Proceedings of ASTRO, Int J Radiat Oncol Biol Phys. 2006;66:S22. Abrams RA, Winter KA, Regine WF, Safran H, Hoffman JP, Konski AA, et al. RTOG 97-04—Radiotherapy Quality Assurance (QA) Review and Survival. Proceedings of ASTRO, Int J Radiat Oncol Biol Phys. 2006;66:S22.
21.
go back to reference Van Laethem J, Van Cutsem E, Hammel P, Mornex F, Azria D, Van Tienhoven G, et al. Adjuvant chemotherapy alone versus chemoradiation after curative resection for pancreatic cancer: feasibility results of a randomized EORTC/FFCD/GERCOR phase I/II study (40013/22012/0304)-abstract 4514. J Clin Oncol 2008;26:216s. Van Laethem J, Van Cutsem E, Hammel P, Mornex F, Azria D, Van Tienhoven G, et al. Adjuvant chemotherapy alone versus chemoradiation after curative resection for pancreatic cancer: feasibility results of a randomized EORTC/FFCD/GERCOR phase I/II study (40013/22012/0304)-abstract 4514. J Clin Oncol 2008;26:216s.
23.
go back to reference Lu DS, Reber HA, Krasny RM, Kadell BM, Sayre J. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. AJR Am J Roentgenol. 1997;168:1439–43.PubMed Lu DS, Reber HA, Krasny RM, Kadell BM, Sayre J. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. AJR Am J Roentgenol. 1997;168:1439–43.PubMed
24.
go back to reference Capussotti L, Massucco P, Ribero D, Vigano L, Muratore A, Calgaro M. Extended lymphadenectomy and vein resection for pancreatic head cancer: outcomes and implications for therapy. Arch Surg. 2003;138:1316–22.PubMedCrossRef Capussotti L, Massucco P, Ribero D, Vigano L, Muratore A, Calgaro M. Extended lymphadenectomy and vein resection for pancreatic head cancer: outcomes and implications for therapy. Arch Surg. 2003;138:1316–22.PubMedCrossRef
25.
go back to reference van Geenen RC, ten Kate FJ, de Wit LT, van Gulik TM, Obertop H, Gouma DJ. Segmental resection and wedge excision of the portal or superior mesenteric vein during pancreatoduodenectomy. Surgery. 2001;129:158–63.PubMedCrossRef van Geenen RC, ten Kate FJ, de Wit LT, van Gulik TM, Obertop H, Gouma DJ. Segmental resection and wedge excision of the portal or superior mesenteric vein during pancreatoduodenectomy. Surgery. 2001;129:158–63.PubMedCrossRef
26.
go back to reference Varadhachary GR, Tamm EP, Abbruzzese JL, Xiong HQ, Crane CH, Wang H, et al. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol. 2006;13:1035–46.PubMedCrossRef Varadhachary GR, Tamm EP, Abbruzzese JL, Xiong HQ, Crane CH, Wang H, et al. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol. 2006;13:1035–46.PubMedCrossRef
27.
go back to reference Katz MHG, Pisters PW, Evans DB, et al. Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J Am College Surgeons. 2008;206:833–48.CrossRef Katz MHG, Pisters PW, Evans DB, et al. Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J Am College Surgeons. 2008;206:833–48.CrossRef
Metadata
Title
Combined Modality Treatment of Resectable and Borderline Resectable Pancreas Cancer: Expert Consensus Statement
Authors
Ross A. Abrams, MD
Andrew M. Lowy, MD
Eileen M. O’Reilly, MD
Robert A. Wolff, MD
Vincent J. Picozzi, MD, MMM
Peter W. T. Pisters, MD
Publication date
01-07-2009
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 7/2009
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0413-9

Other articles of this Issue 7/2009

Annals of Surgical Oncology 7/2009 Go to the issue

ORIGINAL ARTICLE – CONSENSUS REPORT: RESECTABLE AND BORDERLINE RESECTABLE PANCREAS CANCER

Pretreatment Assessment of Resectable and Borderline Resectable Pancreatic Cancer: Expert Consensus Statement

CONSENSUS REPORT: RESECTABLE AND BORDERLINE RESECTABLE PANCREAS CANCER

Surgical Treatment of Resectable and Borderline Resectable Pancreas Cancer: Expert Consensus Statement