Abstracts
1999 Digestive Disease Week

# 2134 NEOADJUVANT CHEMORADIATION FOR LOCALIZED ADENOCARCINOMA OF THE PANCREAS
R R White, Duke Univ Med Ctr (DUMC Box 31118), Durham, NC; H Hurwitz, M Keogan, C Lee, M Anscher, M Gottfried, J Baillie, M Branch, P Jowell, T Pappas, D Tyler, Duke Univ Med Ctr, Durham, NC

Introduction: A major theoretical benefit of neoadjuvant chemoradiation in pancreatic adenocarcinoma is the downstaging of localized disease. The purpose of this study was to determine whether 5FU-based chemoradiation is effective in increasing the resectability and survival of localized pancreatic tumors.
Methods: The charts of 63 patients treated with preoperative chemoradiation for localized pancreatic adenocarcinoma were reviewed. Patients underwent staging CT scan, followed by staging laparoscopy with feeding jejunostomy and Hickman catheter placement. Localized tumors were defined as radiographically resectable (32) in the absence of SMA or celiac axis involvement or portal vein occlusion, borderline resectable (8) with abutment but not encasement of the SMA or celiac axis, or locally advanced (23) with encasement of these vessels. Patients received 4-5 weeks of external beam radiation therapy in daily fractions of 180 cGy. All patients received concurrent 5FU; many also received Mitomycin-C and/or CDDP. Patients were given a 3-4 week break prior to restaging CT scan.
Results: Three patients died prior to restaging. Two patients were not restaged due to treatment intolerance. Of the 58 patients restaged, 18 (35%) showed either no mass lesion (2) or decreased primary disease by CT (16), and 13 (22%) demonstrated stable disease by CT. Local (14) and distant (13) disease progression was seen in 27 patients radiographically. At exploration, 17 patients were resected but only 9 patients had negative margins and lymph nodes. While histologic examination of resection specimens revealed significant tumor fibrosis secondary to chemoradiation, islands of tumor cells persisted in all but one patient. There were two postoperative deaths (<30 days), both from sepsis. Median survival has not been reached but exceeds 11 months.
Conclusion: 5FU-based neoadjuvant chemoradiation had inconsistent effects on altering tumor size, failed to produce significant pathologic downstaging, and resulted in disappointingly low resectability rates. Neoadjuvant therapy has many theoretical benefits in pancreatic cancer; consideration should be given to alternative radiosensitizing agents and/or radiation regimens to improve its efficacy.

Pre-treatment	# of patients	Response by CT	Explored	Resected (% resectability)	Margin	Node
CT staging					negative	negative
Resectable	29	10	22	12(43)	9	9
Borderline	7	2	5	2(25)	1	1
resectable
Locally acvanced	22	6	11	3(13.5)	2	2

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