cqvip:Objectives-The aim of this study was to evaluate the possibility of subsequent resection of locally advanced pancreatic adenocarcinoma after chemotherapy and external-beam radiotherapy.Patients and methods-Between January 1996 and January 2001,33 consecutive patients(18 males and 15 women,mean age 63 years)with locally advanced PA were treated with chemotherapy and concurrent external-beam radiotherapy.Radiotherapy delivered 45-50.4Gy,in a classical manner(N= 27)or on a split course(N = 6).Chemotherapy was made of 5FU by continuous infusion for all patients during 5 weeks and cisplatin at the 1st and 5 weeks(N = 22).Tumor resectability was reassessed at the end of the chemoradiotherapy;surgical resection of tumour was attempted in patients whose tumor demonstrated reduction in size,and supplementary radiotherapy of 10 to 15 Gy was delivered to the others.Results-Thirty-nine percent of patients experienced grade 3 acute toxicity.WHO criteria response to chemoradiotherapy four weeks after the end of treatment were:4 partial responders(12%),6 minor responders(18%),14 stable disease(42%),9 progression(28%).Ten patients underwent exploratory laparotomy,in one case vascular encasement did not allow for tumor resection,and in another patient,there was peritoneal carcinomatosis.In the 8 remaining patients,surgical(RO)resection was possible.In one patient histological examination showed fibrosis with no residual tumour.After a median follow-up period of 40 months,median survival was 16 months(66%and 37%of survival at 1 and 2 years respectively).In operated and non-operated patients,survival rates at 24 months were 73%and 12.5%respectively.At 1 year,80%of the patients treated with radiochemotherapy developed recurrence,metastatic recurrence in 88%.Initial laparotomy,split course radiotherapy were poor outcome factors whereas chemotherapy appears to be a favorable outcome factor.Conclusion-Subsequent resection of locally advanced pancreatic adenocarcinoma is possible after chemoradiotherapy allowing for a prolonged survival in some patients.
展开▼
