This Article Full Text Full Text (PDF) eLetters: Submit a response to this article Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wayne, J. D. Articles by Evans, D. B. Search for Related Content PubMed PubMed Citation Articles by Wayne, J. D. Articles by Evans, D. B.

Localized Adenocarcinoma of the Pancreas: The Rationale for Preoperative Chemoradiation

^a The Departments of Surgical Oncology, ^b Gastrointestinal Medical Oncology, and ^c Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA

Correspondence: Douglas B. Evans, M.D., Department of Surgical Oncology, Box 444, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA. Telephone: 713-794-4324; Fax: 713-745-4426; e-mail: devans{at}mdanderson.org

Pancreatic adenocarcinoma is the fifth leading cause of cancer-related death in the U.S. In spite of advancements in surgical treatment, nearly 80% of patients thought to have localized pancreatic cancer die of recurrent or metastatic disease when treated with surgery alone. Therefore, efforts to alter the patterns of recurrence and improve survival for patients with pancreatic cancer currently focus on the delivery of systemic therapy and irradiation before or after surgery. Postoperative adjuvant therapy appears to improve median survival. However, more than one-fourth of patients do not complete planned adjuvant therapy due to surgical complications or a delay in postoperative recovery of performance status. Utilizing a preoperative (neoadjuvant) approach, overall treatment time is reduced, a greater proportion of patients receive all components of therapy, and patients with rapidly progressive disease are spared the side effects of surgery as metastatic disease may be found at restaging following chemoradiation (prior to surgery).

This paper examines the factors pertinent to clinical trial design for resectable pancreatic cancer, and carefully reviews the existing data supporting adjuvant and neoadjuvant therapy for potentially resectable disease.

Key Words. Adenocarcinoma • Pancreas • Pancreaticoduodenectomy • Antineoplastic agents • Chemotherapy • Radiotherapy • Adjuvant therapy • Neoadjuvant therapy

This article has been cited by other articles:

				R. Le Scodan, F. Mornex, N. Girard, C. Mercier, P.-J. Valette, M. Ychou, F. Bibeau, P. Roy, J.-Y. Scoazec, and C. Partensky Preoperative chemoradiation in potentially resectable pancreatic adenocarcinoma: feasibility, treatment effect evaluation and prognostic factors, analysis of the SFRO-FFCD 9704 trial and literature review Ann. Onc., August 1, 2009; 20(8): 1387 - 1396. [Abstract] [Full Text] [PDF]

				Y.-E. Kim, M.-S. Park, H.-S. Hong, C. M. Kang, J.-Y. Choi, J. S. Lim, W. J. Lee, M.-J. Kim, and K. W. Kim Effects of Neoadjuvant Combined Chemotherapy and Radiation Therapy on the CT Evaluation of Resectability and Staging in Patients with Pancreatic Head Cancer Radiology, March 1, 2009; 250(3): 758 - 765. [Abstract] [Full Text] [PDF]

				J. Kleeff and H. Friess Nonmetastatic Pancreatic Cancer: Many Trials, Little Progress J. Clin. Oncol., June 20, 2008; 26(18): 3100 - 3100. [Full Text] [PDF]

				M. H. G. Katz, R. Hwang, J. B. Fleming, and D. B. Evans Tumor-Node-Metastasis Staging of Pancreatic Adenocarcinoma CA Cancer J Clin, February 13, 2008; (2008) CA.2007.0012v1. [Abstract] [Full Text]

				M. G. del Carmen, I. Rizvi, Y. Chang, A. C. E. Moor, E. Oliva, M. Sherwood, B. Pogue, and T. Hasan Synergism of Epidermal Growth Factor Receptor-Targeted Immunotherapy With Photodynamic Treatment of Ovarian Cancer In Vivo J Natl Cancer Inst, October 19, 2005; 97(20): 1516 - 1524. [Abstract] [Full Text] [PDF]

				Management of pancreatic cancer DTB, May 1, 2003; 41(5): 36 - 40. [Abstract] [Full Text] [PDF]

				A. F.W. Frijhoff, C. J. Conti, and A. M. Senderowicz Second Symposium of Novel Molecular Targets for Cancer Therapy Oncologist, August 1, 2002; 7(90003): 1 - 3. [Full Text] [PDF]