Abstracts
1997 Digestive Disease Week

Resection of locally advanced pancreatic cancer after downstaging with continuous infusion 5-FU, mitomycin C, leucovorin and persantine.

KE Todd, B Gloor, JS Lane, WH Isacoff*, HA Reber. Departments of Surgery and Medicine*, Sepulveda VAMC and UCLA School of Medicine, Los Angeles, CA.

Patients with locally advanced unresectable pancreatic adenocarcinoma (PACA) treated with radiation and 5-FU usually live no more than 8-12 months. Here we report the ability of a 4 drug regimen to downstage the tumor in some patients with this disease, and to prolong survival. Each patient had been diagnosed with locally unresectable pancreatic cancer during exploratory laparotomy or using abdominal CT scan. Following drug treatment for at least 6 months, consideration for curative resection became possible. Methods: From April 1991 to December 1995 we treated 52 patients with 5-FU (200mg/m²-day IV), LV (300mg/m² IV q wk), mitomycin C (10mg/m² IV q 6 wk), & dipyridamole (75 mg po qid) for unresectable PACA (usually because of vascular involvement). There were 28 women and 24 men with a median age of 64 years (range 35-82 years). 46 patients were evaluable for response; 52 for toxicity and survival. Results: There were 2 complete responders and 15 partial responders (CT evidence of tumor regression and [down arrow] CA19-9), for a 34% response rate). The median survival for all patients was 17 months; 1 year survival was 70%. 7/17 responding patients had sufficient tumor regression to justify re-exploration. 5/7 underwent curative resection; 2 patients still were unresectable. Resectable patients had fibrous scar in the areas where vascular invasion by tumor prevented resection at the first operation. The procedure was technically straightforward; there were no significant complications and no operative deaths. Median survival of these 7 patients was 24 months (range 11-48 months) from time of initial diagnosis. One year survival was 86%; 3 patients are alive at 12, 44, and 48 months; 2 are free of disease. Conclusions: This 4 drug regimen achieved a 34% overall response rate in patients with locally advanced PACA. Seven patients responded to the point where reoperation appeared reasonable, and 5 of these underwent a curative resection. This extraordinary experience from a single institution appears to justify a prospective trial of the efficacy of this approach in a larger number of patients from different centers.