Preoperative chemoradiation and IOERT for unresectable or borderline resectable pancreas cancer

Jonathan B. Ashman, Adyr A. Moss, William G. Rule, Matthew G. Callister, Kunam Sudhakar Reddy, David C. Mulligan, Joseph M. Collins, Giovanni De Petris, Leonard L. Gunderson, Mitesh J Borad

Research output: Contribution to journalArticle

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Abstract

Background and objectives: Pre-operative chemoradiation (preop CRT) plus intraoperative electron irradiation (IOERT) has been used in the multidisciplinary treatment for patients with locally advanced unresectable or borderline resectable pancreas cancer. This review was performed to evaluate survival, relapse patterns and prognostic factors in patients treated with curative intent. Methods: Between January 2002 and December 2010, 48 patients with locally advanced pancreatic ductal adenocarcinoma received preop CRT prior to an attempt at resection and IOERT. 31/48 (65%) patients proceeded to curative-intent surgical resection. Resection status prior to preop CRT was locally unresectable (20 patients) and borderline resectable (11 patients). Preop CRT (45-50.4 Gy/25-28 Fx in 27/31) was delivered with concurrent 5FU or gemcitabine-based regimens. Subsequent gross total resection was achieved in 16 patients (R0, 11; R1, 5). IOERT was delivered in 28 patients (dose, 10-20 Gy). 16 patients also received adjuvant post-operative systemic chemotherapy. Outcomes evaluated include survival, local failure in the EBRT field (LF), central failure in the IOERT field (CF), and distant metastases. Results: Resection status was predictive for survival and for patterns of relapse. For patients with at least a gross total resection after preop CRT (R0/R1; n=16) vs. no resection (n=15), both median and overall survival were improved (median 23 vs. 10 months; 2-year, 40% vs. 17%; 3-year, 40% vs. 0%; P=0.002). Liver or peritoneal relapse was documented in 22/31 patients (71%); LF/CF in 5/26 (16%). Conclusions: Long term survival and disease control are achievable in select patients with borderline resectable or locally unresectable pancreas cancer when gross total surgical resection is achieved after preop CRT. Continued evaluation of curative-intent combined modality therapy is warranted in this high risk population, but additional strategies are needed to improve resectability and disease control.

Original languageEnglish (US)
Pages (from-to)352-360
Number of pages9
JournalJournal of Gastrointestinal Oncology
Volume4
Issue number4
DOIs
StatePublished - 2013

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Pancreatic Neoplasms
Electrons
Survival
gemcitabine
Recurrence
Combined Modality Therapy
Fluorouracil
Adenocarcinoma
Neoplasm Metastasis
Drug Therapy

Keywords

  • Chemotherapy
  • Intraoperative procedures
  • Pancreatic neoplasms
  • Radiotherapy
  • Surgery

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

Cite this

Preoperative chemoradiation and IOERT for unresectable or borderline resectable pancreas cancer. / Ashman, Jonathan B.; Moss, Adyr A.; Rule, William G.; Callister, Matthew G.; Reddy, Kunam Sudhakar; Mulligan, David C.; Collins, Joseph M.; De Petris, Giovanni; Gunderson, Leonard L.; Borad, Mitesh J.

In: Journal of Gastrointestinal Oncology, Vol. 4, No. 4, 2013, p. 352-360.

Research output: Contribution to journalArticle

Ashman, JB, Moss, AA, Rule, WG, Callister, MG, Reddy, KS, Mulligan, DC, Collins, JM, De Petris, G, Gunderson, LL & Borad, MJ 2013, 'Preoperative chemoradiation and IOERT for unresectable or borderline resectable pancreas cancer', Journal of Gastrointestinal Oncology, vol. 4, no. 4, pp. 352-360. https://doi.org/10.3978/j.issn.2078-6891.2013.006
Ashman, Jonathan B. ; Moss, Adyr A. ; Rule, William G. ; Callister, Matthew G. ; Reddy, Kunam Sudhakar ; Mulligan, David C. ; Collins, Joseph M. ; De Petris, Giovanni ; Gunderson, Leonard L. ; Borad, Mitesh J. / Preoperative chemoradiation and IOERT for unresectable or borderline resectable pancreas cancer. In: Journal of Gastrointestinal Oncology. 2013 ; Vol. 4, No. 4. pp. 352-360.
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abstract = "Background and objectives: Pre-operative chemoradiation (preop CRT) plus intraoperative electron irradiation (IOERT) has been used in the multidisciplinary treatment for patients with locally advanced unresectable or borderline resectable pancreas cancer. This review was performed to evaluate survival, relapse patterns and prognostic factors in patients treated with curative intent. Methods: Between January 2002 and December 2010, 48 patients with locally advanced pancreatic ductal adenocarcinoma received preop CRT prior to an attempt at resection and IOERT. 31/48 (65{\%}) patients proceeded to curative-intent surgical resection. Resection status prior to preop CRT was locally unresectable (20 patients) and borderline resectable (11 patients). Preop CRT (45-50.4 Gy/25-28 Fx in 27/31) was delivered with concurrent 5FU or gemcitabine-based regimens. Subsequent gross total resection was achieved in 16 patients (R0, 11; R1, 5). IOERT was delivered in 28 patients (dose, 10-20 Gy). 16 patients also received adjuvant post-operative systemic chemotherapy. Outcomes evaluated include survival, local failure in the EBRT field (LF), central failure in the IOERT field (CF), and distant metastases. Results: Resection status was predictive for survival and for patterns of relapse. For patients with at least a gross total resection after preop CRT (R0/R1; n=16) vs. no resection (n=15), both median and overall survival were improved (median 23 vs. 10 months; 2-year, 40{\%} vs. 17{\%}; 3-year, 40{\%} vs. 0{\%}; P=0.002). Liver or peritoneal relapse was documented in 22/31 patients (71{\%}); LF/CF in 5/26 (16{\%}). Conclusions: Long term survival and disease control are achievable in select patients with borderline resectable or locally unresectable pancreas cancer when gross total surgical resection is achieved after preop CRT. Continued evaluation of curative-intent combined modality therapy is warranted in this high risk population, but additional strategies are needed to improve resectability and disease control.",
keywords = "Chemotherapy, Intraoperative procedures, Pancreatic neoplasms, Radiotherapy, Surgery",
author = "Ashman, {Jonathan B.} and Moss, {Adyr A.} and Rule, {William G.} and Callister, {Matthew G.} and Reddy, {Kunam Sudhakar} and Mulligan, {David C.} and Collins, {Joseph M.} and {De Petris}, Giovanni and Gunderson, {Leonard L.} and Borad, {Mitesh J}",
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T1 - Preoperative chemoradiation and IOERT for unresectable or borderline resectable pancreas cancer

AU - Ashman, Jonathan B.

AU - Moss, Adyr A.

AU - Rule, William G.

AU - Callister, Matthew G.

AU - Reddy, Kunam Sudhakar

AU - Mulligan, David C.

AU - Collins, Joseph M.

AU - De Petris, Giovanni

AU - Gunderson, Leonard L.

AU - Borad, Mitesh J

PY - 2013

Y1 - 2013

N2 - Background and objectives: Pre-operative chemoradiation (preop CRT) plus intraoperative electron irradiation (IOERT) has been used in the multidisciplinary treatment for patients with locally advanced unresectable or borderline resectable pancreas cancer. This review was performed to evaluate survival, relapse patterns and prognostic factors in patients treated with curative intent. Methods: Between January 2002 and December 2010, 48 patients with locally advanced pancreatic ductal adenocarcinoma received preop CRT prior to an attempt at resection and IOERT. 31/48 (65%) patients proceeded to curative-intent surgical resection. Resection status prior to preop CRT was locally unresectable (20 patients) and borderline resectable (11 patients). Preop CRT (45-50.4 Gy/25-28 Fx in 27/31) was delivered with concurrent 5FU or gemcitabine-based regimens. Subsequent gross total resection was achieved in 16 patients (R0, 11; R1, 5). IOERT was delivered in 28 patients (dose, 10-20 Gy). 16 patients also received adjuvant post-operative systemic chemotherapy. Outcomes evaluated include survival, local failure in the EBRT field (LF), central failure in the IOERT field (CF), and distant metastases. Results: Resection status was predictive for survival and for patterns of relapse. For patients with at least a gross total resection after preop CRT (R0/R1; n=16) vs. no resection (n=15), both median and overall survival were improved (median 23 vs. 10 months; 2-year, 40% vs. 17%; 3-year, 40% vs. 0%; P=0.002). Liver or peritoneal relapse was documented in 22/31 patients (71%); LF/CF in 5/26 (16%). Conclusions: Long term survival and disease control are achievable in select patients with borderline resectable or locally unresectable pancreas cancer when gross total surgical resection is achieved after preop CRT. Continued evaluation of curative-intent combined modality therapy is warranted in this high risk population, but additional strategies are needed to improve resectability and disease control.

AB - Background and objectives: Pre-operative chemoradiation (preop CRT) plus intraoperative electron irradiation (IOERT) has been used in the multidisciplinary treatment for patients with locally advanced unresectable or borderline resectable pancreas cancer. This review was performed to evaluate survival, relapse patterns and prognostic factors in patients treated with curative intent. Methods: Between January 2002 and December 2010, 48 patients with locally advanced pancreatic ductal adenocarcinoma received preop CRT prior to an attempt at resection and IOERT. 31/48 (65%) patients proceeded to curative-intent surgical resection. Resection status prior to preop CRT was locally unresectable (20 patients) and borderline resectable (11 patients). Preop CRT (45-50.4 Gy/25-28 Fx in 27/31) was delivered with concurrent 5FU or gemcitabine-based regimens. Subsequent gross total resection was achieved in 16 patients (R0, 11; R1, 5). IOERT was delivered in 28 patients (dose, 10-20 Gy). 16 patients also received adjuvant post-operative systemic chemotherapy. Outcomes evaluated include survival, local failure in the EBRT field (LF), central failure in the IOERT field (CF), and distant metastases. Results: Resection status was predictive for survival and for patterns of relapse. For patients with at least a gross total resection after preop CRT (R0/R1; n=16) vs. no resection (n=15), both median and overall survival were improved (median 23 vs. 10 months; 2-year, 40% vs. 17%; 3-year, 40% vs. 0%; P=0.002). Liver or peritoneal relapse was documented in 22/31 patients (71%); LF/CF in 5/26 (16%). Conclusions: Long term survival and disease control are achievable in select patients with borderline resectable or locally unresectable pancreas cancer when gross total surgical resection is achieved after preop CRT. Continued evaluation of curative-intent combined modality therapy is warranted in this high risk population, but additional strategies are needed to improve resectability and disease control.

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KW - Intraoperative procedures

KW - Pancreatic neoplasms

KW - Radiotherapy

KW - Surgery

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