Annals of Oncology Advance Access published online on June 5, 2009
Annals of Oncology, doi:10.1093/annonc/mdp015
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Preoperative chemoradiation in potentially resectable pancreatic adenocarcinoma: feasibility, treatment effect evaluation and prognostic factors, analysis of the SFRO-FFCD 9704 trial and literature review
1 Department of Radiation Oncology
2 Department of Medical Statistics, Centre Hospitalier Lyon-Sud, Pierre-Bénite
3 Department of Digestive Radiology, Hôpital Edouard Herriot, Lyon
4 Department of Medical Oncology
5 Department of Pathology, Centre Val d’Aurelle, Montpellier
6 Department of Pathology
7 Department of Digestive Surgery, Hôpital Edouard Herriot, Lyon, France
* Correspondence to: Dr F. Mornex, Department of Radiation Oncology, Centre Hospitalier Lyon-Sud, 165 Chemin du Grand Revoyet, 69495 Pierre-Bénite, France. Tel: +33-478864265; Fax: +33-478864263; E-mail: francoise.mornex{at}chu-lyon.fr
Background: We explored the feasibility and the histologic assessment of treatment effect of preoperative chemoradiation in patients presenting with resectable pancreatic adenocarcinoma.
Patients and methods: Treatment consisted of concurrent radiotherapy (50 Gy within 5 weeks) and chemotherapy with 5-fluorouracil (300 mg/m2/day, 5 days/week, weeks 1–5) and cisplatin (20 mg/m2/day, days 1–5 and 29–33), followed by surgical resection of the pancreatic tumor in patients without progression.
Results: In all, 41 patients were enrolled; 38 (93%) received 
47 Gy; 30 patients (73%) received 75% of the prescribed doses of chemotherapy. Among 40 assessable patients, 27 (67.5%; 95% confidence interval 50.9% to 81.4%) were successfully treated (entire dose of radiation, 75% of the chemotherapy dose, no grade 4 non-hematologic toxicity). In all, 26 patients (63%) underwent surgical resection with curative intent and 21 (80.7%) had R0 resection. A total of 13 of 26 specimens (50%) presented a major pathologic response (80% of severely degenerative cancer cells), with one complete pathologic response. Operative mortality was 2.8%. The local recurrence and 2-year survival rates were 4% and 32%, respectively, for the 26 operated patients.
Conclusions: This proposed preoperative scheme is feasible, does not prevent successful surgery, and provides antitumoral effect associated with major histopathological response in 50% of patients and a high R0 resection rate.
chemoradiation, histopathological response, neoadjuvant treatment, pancreatic adenocarcinoma
Received for publication August 8, 2008. Revision received December 18, 2008. Accepted for publication January 12, 2009.