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Preoperative gemcitabine based chemo-radiotherapy in locally advanced non metastatic pancreatic adenocarcinoma.

Maximous DW, Abdel-Wanis ME, El-Sayed MI, Abd-Elsayed AA - Int Arch Med (2009)

Bottom Line: Hepatic toxicity, nausea, and vomiting were found in 8 patients (32%), 10 patients (40%) and 4 patients (16%), respectively.The median survival of all patients was 12 months.Preoperative gemcitabine based chemoradiation might benefit patients with locally advanced non metastatic pancreatic cancer by increasing the resectability without significant acute toxicity.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of surgical oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt. doaawadie@hotmail.com

ABSTRACT

Introduction: Almost 30% of patients with pancreatic cancer have locally advanced tumours in absence of distant metastasis. Surgical resection is often contraindicated. The combination of gemcitabine with concurrent radiation therapy is a promising new approach that is being investigated for treating patients' unresectable pancreatic cancer. This work aims at assessing the efficacy of preoperative gemcitabine based chemo-radiotherapy in increasing the resectability rate for patients' locally advanced pancreatic cancer.

Patients and methods: From March 2006 to November 2007, 25 patients with locally advanced non metastatic pancreatic cancer were treated by preoperative gemcitabine based chemo-radiotherapy. The radiation dose was 54 Gray in 30 fractions over 6 weeks prescribed to the isocenter. Gemcitabine (300 mg/m2) was given through a 30 minute intravenous infusion. This was done 30 minutes before the radiation sitting on a weekly basis throughout the radiotherapy course.Approximately 6 weeks after the completion of chemo radiation, an evaluation was performed regarding tumour response and resectability as well as acute toxicity. Pancreaticoduodenectomy was performed for operable patients with surgical reconstruction.

Results: Patients who achieved complete resection (CR) numbered 2 (8%), while those achieving partial resection (PR) totalled 11 (44%); six of these patients were considered ro be operable. Thus Pancreaticoduodenectomy was performed on 8 patients (2 with CR and 6 with PR) with surgical reconstruction. Patients who had a stable disease numbered 4 (16%), and those with progressive diseases included a group of eight (32%). The postoperative 30 day mortality occurred only in one patient (12.5%). Acute toxicity of chemoradiation occurred in the form of grade I leucopoenia and thrombocytopenia. Hepatic toxicity, nausea, and vomiting were found in 8 patients (32%), 10 patients (40%) and 4 patients (16%), respectively. The postoperative 30 day mortality occurred only in 1 patient. Also, minor biliary leakage and leakage from gastrointestinal anaestomosis both occurred in a single patient. Out of the 8 patients who underwent radical surgical resection, only one developed local recurrence and simultaneous liver metastasis during the follow up period. The median survival of all patients was 12 months.

Conclusion: Preoperative gemcitabine based chemoradiation might benefit patients with locally advanced non metastatic pancreatic cancer by increasing the resectability without significant acute toxicity.

No MeSH data available.


Related in: MedlinePlus

Overall survival curves in both resected and unresected cases.
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Figure 2: Overall survival curves in both resected and unresected cases.

Mentions: Toxicities of preoperative chemoradiation were mainly haematological, where grade 1 leucopoenia and thrombocytopenia were found in 8 out of 25 patients (32%), grade 1 hepatic toxicity was discovered in 10 patients (40%), and grade 1 nausea and vomiting occurred in 4 patients (16%). The postoperative 30 day mortality occurred only in one patient (12.5%) due to a reactionary haemorrhage from the portal vein. The postoperative morbidity occurred in the form of minor biliary leakage (1 patient, 12.5%) and leakage from gastrointestinal anastomosis (1 patient, 12.5%) that healed conservatively. Delayed gastric emptying occurred in 3 patients (37.5%).


Preoperative gemcitabine based chemo-radiotherapy in locally advanced non metastatic pancreatic adenocarcinoma.

Maximous DW, Abdel-Wanis ME, El-Sayed MI, Abd-Elsayed AA - Int Arch Med (2009)

Overall survival curves in both resected and unresected cases.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2667390&req=5

Figure 2: Overall survival curves in both resected and unresected cases.
Mentions: Toxicities of preoperative chemoradiation were mainly haematological, where grade 1 leucopoenia and thrombocytopenia were found in 8 out of 25 patients (32%), grade 1 hepatic toxicity was discovered in 10 patients (40%), and grade 1 nausea and vomiting occurred in 4 patients (16%). The postoperative 30 day mortality occurred only in one patient (12.5%) due to a reactionary haemorrhage from the portal vein. The postoperative morbidity occurred in the form of minor biliary leakage (1 patient, 12.5%) and leakage from gastrointestinal anastomosis (1 patient, 12.5%) that healed conservatively. Delayed gastric emptying occurred in 3 patients (37.5%).

Bottom Line: Hepatic toxicity, nausea, and vomiting were found in 8 patients (32%), 10 patients (40%) and 4 patients (16%), respectively.The median survival of all patients was 12 months.Preoperative gemcitabine based chemoradiation might benefit patients with locally advanced non metastatic pancreatic cancer by increasing the resectability without significant acute toxicity.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of surgical oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt. doaawadie@hotmail.com

ABSTRACT

Introduction: Almost 30% of patients with pancreatic cancer have locally advanced tumours in absence of distant metastasis. Surgical resection is often contraindicated. The combination of gemcitabine with concurrent radiation therapy is a promising new approach that is being investigated for treating patients' unresectable pancreatic cancer. This work aims at assessing the efficacy of preoperative gemcitabine based chemo-radiotherapy in increasing the resectability rate for patients' locally advanced pancreatic cancer.

Patients and methods: From March 2006 to November 2007, 25 patients with locally advanced non metastatic pancreatic cancer were treated by preoperative gemcitabine based chemo-radiotherapy. The radiation dose was 54 Gray in 30 fractions over 6 weeks prescribed to the isocenter. Gemcitabine (300 mg/m2) was given through a 30 minute intravenous infusion. This was done 30 minutes before the radiation sitting on a weekly basis throughout the radiotherapy course.Approximately 6 weeks after the completion of chemo radiation, an evaluation was performed regarding tumour response and resectability as well as acute toxicity. Pancreaticoduodenectomy was performed for operable patients with surgical reconstruction.

Results: Patients who achieved complete resection (CR) numbered 2 (8%), while those achieving partial resection (PR) totalled 11 (44%); six of these patients were considered ro be operable. Thus Pancreaticoduodenectomy was performed on 8 patients (2 with CR and 6 with PR) with surgical reconstruction. Patients who had a stable disease numbered 4 (16%), and those with progressive diseases included a group of eight (32%). The postoperative 30 day mortality occurred only in one patient (12.5%). Acute toxicity of chemoradiation occurred in the form of grade I leucopoenia and thrombocytopenia. Hepatic toxicity, nausea, and vomiting were found in 8 patients (32%), 10 patients (40%) and 4 patients (16%), respectively. The postoperative 30 day mortality occurred only in 1 patient. Also, minor biliary leakage and leakage from gastrointestinal anaestomosis both occurred in a single patient. Out of the 8 patients who underwent radical surgical resection, only one developed local recurrence and simultaneous liver metastasis during the follow up period. The median survival of all patients was 12 months.

Conclusion: Preoperative gemcitabine based chemoradiation might benefit patients with locally advanced non metastatic pancreatic cancer by increasing the resectability without significant acute toxicity.

No MeSH data available.


Related in: MedlinePlus