Abstracts
2000 Digestive Disease Week

# 2313 Does Chemoradiation Downstage Locally Advanced Pancreatic Cancer?
Hong Jin Kim, Karen Czischke, Murray F Brennan, Kevin Conlon, New York, NY

Introduction: Recent studies suggest that neoadjuvant chemoradiation can downstage locally advanced pancreatic tumors from unresectable to resectable. However, there is limited data to support this approach. Studies evaluating the efficacy of preoperative regimens may be criticized for lack of standardization in staging criteria. The purpose of this study was to review our experience with preoperative chemoradiation for surgically-staged locally unresectable pancreatic cancer and to determine whether patients are downstaged with aggressive therapy allowing for curative resection. Methods: A prospectively-collected database of patients at our institution with biopsy-proven, locally advanced pancreatic adenocarcinoma was reviewed from January 1993 to March 1999. Tumors were defined as locally advanced based on intraoperative evidence of extensive vascular involvement (n=163). 87/163 (53.3%) received chemoradiation regimens varying from standard 5-FU/Gemcitabine based therapies to experimental protocols, with followup in 85 patients. Clinicopathological and operative details were reviewed. Results: Only 3 patients (3/87; 3.4%) had sufficient clinical response to neoadjuvant therapy on restaging to warrant a reexploration for possible surgical resection. Of these patients, 2/3 were deemed unresectable on laparoscopic restaging secondary to vascular involvement or metastatic disease (peritoneal dissemination). One patient survived 13 months, and the other is alive with disease at 16 months. Only 1 patient had sufficient objective response to preoperative therapy to undergo a curative pancreaticoduodenectomy, with a survival of 18 months despite pathologic negative margins and no lymph node involvement. The overall median survival for patients with locally unresectable pancreatic cancer treated with aggressive chemoradiation at our institution is 11 months (6.5 months without adjuvant treatment, p=0.004). Conclusions: Although chemoradiation is associated with an improvement in overall survival for locally advanced disease, it rarely permits curative pancreatic resections in adequately staged patients. Neoadjuvant chemoradiation has many theoretical advantages; however, clinical downstaging of accuratelystaged locally advanced pancreatic cancer is rare with current therapeutic regimens. Standardized multimodality therapies need to be evaluated with randomized prospective trials, and novel approaches are required for the treatment of locally advanced pancreatic cancer.