Neoadjuvant GTX Chemotherapy and IMRT-based chemoradiation for borderline resectable pancreatic cancer
✍ Scribed by Manish Patel; Sarah Hoffe; Mokenge Malafa; Pamela Hodul; Jason Klapman; Barbara Centeno; Jongphil Kim; James Helm; Tiffany Valone; Gregory Springett
- Publisher
- John Wiley and Sons
- Year
- 2011
- Tongue
- English
- Weight
- 217 KB
- Volume
- 104
- Category
- Article
- ISSN
- 0022-4790
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✦ Synopsis
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. J. Surg. Oncol. 2011;104:155–161. © 2011 Wiley‐Liss, Inc.