Adjuvant and Neoadjuvant Therapy in Curable Pancreatic Cancer

Surgical Clinics of North America

Volumn 90, Issue 2, 2010, Pages 323-339

  Nugent, F W ^a   Stuart, Keith ^a  

^a LAHEY HOSPITAL AND MEDICAL CENTER   (United States)

Author keywords

Adjuvant chemotherapy; Pancreatic cancer; Radiotherapy

Indexed keywords

CISPLATIN; DOXORUBICIN; FLUOROURACIL; FOLINIC ACID; GEMCITABINE; INTERFERON; MITOMYCIN C;

ADJUVANT THERAPY; CANCER ADJUVANT THERAPY; CANCER CHEMOTHERAPY; CANCER DIAGNOSIS; CANCER EPIDEMIOLOGY; CANCER IMMUNOTHERAPY; CANCER INCIDENCE; CANCER MORTALITY; CANCER RADIOTHERAPY; CANCER RELAPSE; CLINICAL TRIAL; CONTINUOUS INFUSION; DISEASE SURVEILLANCE; DRUG MECHANISM; DRUG POTENTIATION; DRUG WITHDRAWAL; GASTROINTESTINAL TOXICITY; HUMAN; METASTASIS; MULTIPLE CYCLE TREATMENT; OVERALL SURVIVAL; PANCREAS CANCER; PANCREAS RESECTION; PREOPERATIVE EVALUATION; PRIORITY JOURNAL; RADIATION DOSE FRACTIONATION; RADIATION INJURY; REVIEW; SURVIVAL TIME; UNITED STATES; UNSPECIFIED SIDE EFFECT;

ANTIMETABOLITES, ANTINEOPLASTIC; CHEMOTHERAPY, ADJUVANT; DEOXYCYTIDINE; DISEASE-FREE SURVIVAL; HUMANS; NEOADJUVANT THERAPY; PANCREATECTOMY; PANCREATIC NEOPLASMS; RADIOTHERAPY, ADJUVANT; RANDOMIZED CONTROLLED TRIALS AS TOPIC; SEER PROGRAM; SURVIVAL ANALYSIS;

EID: 77950824998     PISSN: 00396109     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.suc.2009.12.010     Document Type: Review

References (44)

1. American Cancer Society: 2008 Cancer facts and figures. Atlanta, GA; 2008.
2. Jemal A., Murray T., Samuels A., et al. Cancer statistics, 2003. CA Cancer J Clin 2003, 53(1):5-26.
3. Prolongation of the disease-free interval in surgically treated rectal carcinoma. Gastrointestinal Tumor Study Group. N Engl J Med 1985, 312(23):1465-1472.
4. Kalser M.H., Ellenberg S.S. Pancreatic cancer adjuvant combined radiation and chemotherapy following curative resection. Arch Sug 1985, 120:899-903.
5. Smeenk H.G., van Eijck C.H., Hop W.C., et al. Long-term survival and metastatic pattern of pancreatic and periampullary cancer after adjuvant chemoradiation or observation long-term results of EORTC Trial 40891. Ann Surg 2007, 246(5):734-740.
6. Griffin J.F., Smalley S.R. Patterns of failure after curative resection of pancreatic carcinoma. Cancer 1990, 66(1):56-61.
7. Tepper J., Nardi G., Suit H. Carcinoma of the pancreas: review of MGH experience from 1963 to 1973 - analysis of surgical failure and implications for radiation therapy. Cancer 1976, 37:1519-1524.
8. Van den Broeck A., Sergeant G., Ectors N., et al. Patterns of recurrence after curative resection of pancreatic ductal adenocarcinoma. Eur J Surg Oncol 2009, 35(6):600-604.
9. Westerdahl J., Andren-Sandberg A., Ihse I. Recurrence of exocrine pancreatic cancer-local or hepatic?. Hepatogastroenterology 1993, 40(4):384-387.
10. Regine W.F., Winter K.W., Abrams R., et al. RTOG 9704 a phase III study of adjuvant pre and post chemoradiation (CRT) 5-FU vs. gemcitabine (G) for resected pancreatic adenocarcinoma. J Clin Oncol 2006, 24(18S):4007. 2006 ASCO Annual Meeting Proceedings (Post Meeting Edition).
11. Swartz M.J., Abrams R.A., Winter J., et al. Adjuvant chemoradiation for adenocarcinoma of the pancreas: the Johns Hopkins experience. Int J Radiat Oncol Biol Phys 2006, 66(3 Suppl 1):S82.
12. Yeo C.J., Abrams R.A., Grochow L.B., et al. Pancreaticoduodenectomy for pancreatic adenocarcinoma: postoperative adjuvant chemoradiation improves survival. Ann Surg 1997, 225(5):621-636.
13. Corsini M.M., Miller R.C., Haddock M.G., et al. Adjuvant radiotherapy and chemotherapy for pancreatic carcinoma: the Mayo Clinic experience (1975-2005). J Clin Oncol 2008, 26(21):3511-3516.
14. Artinyan A., Hellan M., Mojica-Manosa P., et al. Improved survival with adjuvant external-beam radiation therapy in lymph node-negative pancreatic cancer. 2007 doi: 10.1002/cncr.23134 American Cancer Society Published online 13 November 2007 in Wiley InterScience. Available at:, Accessed September 1, 2009. http://www.interscience.wiley.com.
15. Moody J.S., Sawrie S.M., Kozak K.R., et al. Adjuvant radiotherapy for pancreatic cancer is associated with a survival benefit primarily in state IIB patients. J Gastroenterol 2009, 44:84-91. 10.1007/s00535-008-2280-8.
16. Greco JA, Castaldo ET, Feurer ID, et al. Survival benefit with adjuvant radiation in surgically resected pancreatic cancer [abstract 109]. ASCO Gastrointestinal Cancers Symposium Proceedings 2007.
17. Klinkenbijl J.H., Jeekel J., Sahmoud T., et al. Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group. Ann Surg 1999, 230(6):776-784.
18. Garofalo M.C., Regine W.F., Tan M.T. On statistical reanalysis, the EORTC trial is a positive trail for adjuvant chemoradiation in pancreatic cancer. Ann Surg 2006, 244(2):332-333.
19. Gutt R., Liauw S.L., Weichselbaum R.R. Adjuvant radiotherapy for resected pancreatic cancer: a lack of benefit or a lack of adequate trials?. Nat Clin Pract Gastroenterol Hepatol 2009, 6(1):38-46. Available at:, Accessed September 1, 2009. http://www.nature.com/clinicalpractice/gasthep.
20. O'Connell J.B., Maggard M.A., Manunga J., et al. Survival after resection of ampullary carcinoma: a national population-based study. Ann Surg Oncol 2008, 15(7):1820-1827.
21. Neoptolemos J.P., Stocken D.D., Friess H., et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 350; 12 Available at:, Accessed March 18, 2004. http://www.NEJM.Org.
22. Oettle H., Post S., Neuhaus P., et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer. A randomized controlled trial. JAMA 2007, 297(3):267-277. Available at:, Accessed September 1, 2009. http://www.jama.com.
23. Neuhaus P., Riess H., Post S., et al. Oettle Deutsche Krebsgesellschaft (CAO/AIO). CONKO-001: Final results of the randomized, prospective, multicenter phase III trial of adjuvant chemotherapy with gemcitabine versus observation in patients with resected pancreatic cancer (PC). J Clin Oncol 2008, 26(15S (May 20 Supplement)):LBA4504. 2008 ASCO Annual Meeting Proceedings (Post-Meeting Edition).
24. Neoptolemos J., Buchler M., Stocken D.D., et al. ESPAC-3(v2): a multicenter, international, open-label, randomized, controlled phase III trial of adjuvant 5-fluorouracil/folinic acid (5-FU/FA) versus gemcitabine (GEM) in patients with resected pancreatic ductal adenocarcinoma. J Clin Oncol 2009, 27(Suppl). [abstract LBA4505], 18S.
25. Ueno H., Kosuge T., Matsuyama Y., et al. A randomized phase III trial comparing gemcitabine with surgery-only in patients with resected pancreatic cancer: Japanese Study Group of Adjuvant Therapy for Pancreatic Cancer. Br J Cancer 2009, 101:908-915.
26. Bakkevold K.E., Arnesjo B., Dahl O., et al. Adjuvant combination chemotherapy (AMF) following radical resection of carcinoma of the pancreas and papilla of Vater - results of a controlled, prospective, randomised multicentre study. Eur J Cancer 1993, 29(5):698-703.
27. Takada T., Amano H., Yasuda H., et al. Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma?. 2002 American Cancer Society Cancer 2002, 95(8):1685-1695.
28. Fuhrman G.M., Charnsangavej C., Abbruzzese J.L., et al. Thin-section contrast-enhanced computed tomography accurately predicts resectability of malignant pancreatic neoplasms. Am J Surg 1994, 167:104.
29. Evans D.B., Varadhachary G.R., Crane C.H., et al. Preoperative gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head. J Clin Oncol 2008, 26(21):3496-3502.
30. Varadhachary G.R., Wolff R.A., Crane C.H., et al. Preoperative gemcitabine and cisplatin followed by gemcitabine-based chemoradiation for resectable adenocarcinoma of the pancreatic head. J Clin Oncol 2008, 26(21):3487-3495. 10.1200/JCO.2007.15.8642.
31. Sohn TA, Yeo CJ, Cameron JL, et al. Resected adenocarcinoma of the pancreas - 616 patients: results, outcomes, and prognostic indicators. From the Departments of Surgery, Pathology (RHH), and Oncology (RAA), The Johns Hopkins Medical Institutions, Baltimore, MD. Presented at the Forty-First Annual Meeting of The Society for Surgery of the Alimentary Tract, San Diego, CA, May 21-24, 2000.
32. Hirai T., Matsumoto H., Yamashita K., et al. Surgical oncotaxis-excessive surgical stress and postoperative complications contribute to enhancing tumor metastasis, resulting in a poor prognosis for cancer patients. Ann Thorac Cardiovasc Surg 2005, 11(1):4-6.
33. Spitz F.R., Abbruzzese J.L., Lee J.E., et al. Preoperative and postoperative chemoradiation strategies in patients treated with pancreaticoduodenectomy for adenocarcinoma of the pancreas. J Clin Oncol 1997, 15(3):928-937.
34. White R.R., Tyler D.S. Neoadjuvant therapy for pancreatic cancer: the Duke experience. Surg Oncol Clin N Am 2004, 13:675-684.
35. Hoffman J.P., Weese J.L., Solin L.J., et al. A pilot study of preoperative chemoradiation for patients with localized adenocarcinoma of the pancreas. Am J Surg 1995, 169(1):71-77. [discussion: 77-8].
36. Hoffman J.P., Lipsitz S., Pisansky T., et al. Phase II trial of preoperative radiation therapy and chemotherapy for patients with localized, resectable adenocarcinoma of the pancreas: an Eastern Cooperative Oncology Group Study. J Clin Oncol 1998, 16(1):317-323.
37. Wadler S., Schwartz E.L. Antineoplastic activity of the combination of interferon and cytotoxic agents against experimental and human malignancies: a review. Cancer Res 1990, 50(12):3473-3486.
38. Vokes E.E. The promise of biochemical modulation in combined modality therapy. Semin Oncol 1994, 21(6 Suppl 14):29-33.
39. Holsti L.R., Mattson K., Niiranen A., et al. Enhancement of radiation effects by alpha interferon in the treatment of small cell carcinoma of the lung. Int J Radiat Oncol Biol Phys 1987, 13(8):1161-1166.
40. Nukui Y., Picozzi V.J., Traverso L.W. Interferon-based adjuvant chemoradiation therapy improves survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am J Surg 2000, 179:367-371.
41. Picozzi V.J., Kozarek R.A., Traverso L.W. Interferon-based adjuvant chemoradiation therapy after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am J Surg 2003, 185(5):476-480.
42. Picozzi V.J., Abrams R.A., Traverso L.W., et al. ACOSOG Z05031: Report on a multicenter, phase II trial for adjuvant therapy of resected pancreatic cancer using cisplatin, 5- FU, and alpha-interferon. J Clin Oncol 2008, 26(15S):4505. 2008 ASCO Annual Meeting Proceedings (Post Meeting Edition).
43. Linehan D.C., Tan M.C.B., Strasberg S.M., et al. Adjuvant interferon-based chemoradiation followed by gemcitabine for resected pancreatic adenocarcinoma: a single-institution phase II study. Ann Surg 2008, 248(2):145-151.
44. Marten A., Schmidt J., Ose J., et al. A randomized multicentre phase ii trial comparing adjuvant therapy in patients with interferon alpha-2b and 5-fu alone or in combination with either external radiation treatment and Cisplatin (CapRI) or radiation alone regarding event-free survival - CapRI-2. BMC Cancer 2009, 9:160. Available at:, Accessed September 1, 2009. http://www.biomedcentral.com/1471-2407/9/160, 10.1186/1471-2407-9-160.