Neoadjuvant GTX chemotherapy and IMRT-based chemoradiation for borderline resectable pancreatic cancer

J Surg Oncol. 2011 Aug 1;104(2):155-61. doi: 10.1002/jso.21954. Epub 2011 Apr 25.

Abstract

Background and objectives: To improve the likelihood of achieving a margin-free resection, neoadjuvant induction chemotherapy with GTX (gemcitabine, docetaxel, and capecitabine) followed by 5-FU-IMRT was administered to patients with borderline resectable pancreatic cancer. The utility of computed tomography (CT), endoscopic ultrasound (EUS), positron emission tomography (PET), and CA 19-9 during diagnostic workup and assessment of response was also examined.

Methods: Seventeen patients with borderline resectable pancreatic cancer received a median of three cycles of neoadjuvant GTX induction chemotherapy followed by 5-FU-IMRT with dose painting. CA 19-9, CT mass size, and PET SUV were examined before and after neoadjuvant treatment.

Results: Diagnostic EUS and CT scans displayed similar mean mass sizes and extent of vascular involvement. Eight of the 17 patients achieved an R0 resection. Median CA 19-9 levels, CT mass size, and PET SUV all significantly decreased after neoadjuvant therapy. The median progression-free survival and overall survival were 10.48 and 15.64 months, respectively. Six patients are still alive.

Conclusions: Neoadjuvant GTX induction chemotherapy followed by 5-FU-IMRT shows promise in improving the likelihood of resectability with negative margins in borderline resectable pancreatic cancer. CT and EUS play complimentary roles during diagnostic workup. CT scans, CA 19-9, and PET scans are useful in judging response to neoadjuvant therapy.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenocarcinoma / diagnosis
  • Adenocarcinoma / therapy*
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use*
  • CA-19-9 Antigen
  • Capecitabine
  • Deoxycytidine / administration & dosage
  • Deoxycytidine / analogs & derivatives
  • Docetaxel
  • Female
  • Fluorouracil / administration & dosage
  • Fluorouracil / analogs & derivatives
  • Humans
  • Male
  • Middle Aged
  • Neoadjuvant Therapy
  • Pancreatic Neoplasms / diagnosis
  • Pancreatic Neoplasms / therapy*
  • Pancreaticoduodenectomy
  • Radiotherapy, Intensity-Modulated
  • Retrospective Studies
  • Taxoids / administration & dosage

Substances

  • Antineoplastic Agents
  • CA-19-9 Antigen
  • Taxoids
  • Deoxycytidine
  • Docetaxel
  • Capecitabine
  • gemcitabine
  • Fluorouracil