Document Detail


Neoadjuvant chemotherapy generates a significant tumor response in resectable pancreatic cancer without increasing morbidity: results of a prospective phase II trial.
MedLine Citation:
PMID:  19092346     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate the morbidity of pancreaticoduodenectomy after neoadjuvant chemotherapy for resectable pancreatic cancer and to assess its histologic and metabolic response.
BACKGROUND: Adjuvant chemotherapy improves the outcome of pancreatic cancer, but 25% of patients remain unfit after surgery. Neoadjuvant chemotherapy can be offered to all patients in a multimodality approach, but its efficacy and surgical morbidity are unknown.
METHODS: Patients with resectable, cytologically proven adenocarcinoma of the pancreatic head received 4 bi-weekly cycles of gemcitabine (1000 mg/m(2)) and cisplatin (50 mg/m(2)) in this prospective phase II trial. Staging and restaging included chest x-ray, abdominal computed tomography (CT), positron emission tomography (PET)/CT, endoscopic ultrasound, and laparoscopy. Fluorodeoxyglucose uptake was quantified by the standard-uptake value (SUV) on baseline and restaging PET/CT. Immunohistochemistry for GLUT-1 and Ki-67 was performed. The histologic response, cytopathic effects, and surgical complications were graded by respective scores.
RESULTS: Twenty-four of 28 patients had resection for histologically confirmed adenocarcinoma. The surgical morbidity was low without perioperative death and one pancreatic fistula. Histologic response was documented in 54% and cytopathic effects in 83% of the patients. A significant SUV decrease occurred during chemotherapy (P = 0.031), which correlated with the baseline SUV (P = 0.001), Ki-67 expression (P = 0.016), and histologic response (P = 0.01). Neither the metabolic nor the histologic response was predictive of the median disease-free (9.2 months) or overall survival (26.5 months).
CONCLUSION: Neoadjuvant chemotherapy induced a significant metabolic and histologic response, which was best predicted by PET. Most importantly, surgery after neoadjuvant chemotherapy for pancreatic cancer was safe.
Authors:
Stefan Heinrich; Markus Schäfer; Achim Weber; Thomas F Hany; Ujwal Bhure; Bernhard C Pestalozzi; Pierre-Alain Clavien
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Publication Detail:
Type:  Clinical Trial, Phase II; Journal Article    
Journal Detail:
Title:  Annals of surgery     Volume:  248     ISSN:  1528-1140     ISO Abbreviation:  Ann. Surg.     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-12-18     Completed Date:  2009-01-13     Revised Date:  2013-06-03    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1014-22     Citation Subset:  AIM; IM    
Affiliation:
Swiss HPB-Center, Department of Surgery and Institute of Surgical Pathology, Zurich, Switzerland.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00490360
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MeSH Terms
Descriptor/Qualifier:
Adenocarcinoma / blood,  drug therapy*,  mortality,  surgery*
Antineoplastic Combined Chemotherapy Protocols / therapeutic use
CA-19-9 Antigen / blood
Chemotherapy, Adjuvant
Cisplatin / administration & dosage
Deoxycytidine / administration & dosage,  analogs & derivatives
Disease-Free Survival
Humans
Morbidity
Neoadjuvant Therapy*
Pancreatic Neoplasms / blood,  drug therapy*,  mortality,  surgery*
Pancreaticoduodenectomy*
Positron-Emission Tomography
Prospective Studies
Chemical
Reg. No./Substance:
0/CA-19-9 Antigen; 15663-27-1/Cisplatin; 951-77-9/Deoxycytidine; B76N6SBZ8R/gemcitabine

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