Neoadjuvant chemoradiotherapy for adenocarcinoma of the pancreas

Analysis of histopathology and outcome

Aaron R Sasson, R. Wesley Wetherington, John P. Hoffman, Eric A. Ross, Harry Cooper, Neal J. Meropol, Gary Freedman, James F. Pingpank, Burton L. Eisenberg

Research output: Contribution to journalReview article

66 Citations (Scopus)

Abstract

To examine the histopathologic effect of neoadjuvant therapy and its impact on survival in patients with carcinoma of the pancreas, we retrospectively reviewed the records of 116 patients who underwent resections for pancreatic cancer from 1987 to 2000. Median follow-up of surviving patients was 19 mo (range 4-150 mo). Preoperative chemotherapy was administered in 61 patients (53%) and consisted of 5-fluorouracil/mitomycin C in 35 patients and gemcitabine in 26 patients, given concurrently with external beam radiation (5040 cGy). All resections were performed with curative intent (98 Whipples, 11 total, 6 distal, and 1 central pancreatectomy). Histopathologic examination included an estimation of the amount of fibrosis present in the tumor specimen (expressed as the percentage of fibrosis identified relative to the amount of neoplastic cells present). The mean fibrosis level for the series was 56% (range 5% to 100%). The administration of neoadjuvant therapy resulted in greater fibrosis (73%) than no preoperative treatment (38%) (p = 0.0001). Higher mean fibrosis levels were observed in patients with negative lymph nodes (p = 0.0006) and negative margins (p = 0.05). Factors associated with improved survival (log rank test) included: negative margins (p = 0.001), negative lymph nodes (p = 0.03), and use of neoadjuvant therapy (p = 0.03). Median survival in the neoadjuvant group was 23 mo vs 16 mo without preoperative therapy (p = 0.03). In conclusion, the use of neoadjuvant therapy resulted in a greater degree of fibrosis in the specimen. Patients with negative margins and negative lymph nodes had a greater amount of fibrosis present, and these were significant predictors of improved outcome. Although retrospective, this series suggests an improvement in survival in patients treated with neoadjuvant therapy.

Original languageEnglish (US)
Pages (from-to)121-127
Number of pages7
JournalInternational Journal of Gastrointestinal Cancer
Volume34
Issue number2-3
StatePublished - Oct 7 2004

Fingerprint

Chemoradiotherapy
Pancreas
Adenocarcinoma
Neoadjuvant Therapy
Fibrosis
Survival
Lymph Nodes
gemcitabine
Pancreatectomy
Mitomycin
Pancreatic Neoplasms
Fluorouracil
Radiation
Carcinoma
Drug Therapy
Therapeutics

Keywords

  • Adjuvant treatment
  • Chemotherapy
  • Histopathology
  • Pancreatic cancer
  • Radiotherapy

ASJC Scopus subject areas

  • Gastroenterology
  • Endocrinology
  • Oncology

Cite this

Sasson, A. R., Wetherington, R. W., Hoffman, J. P., Ross, E. A., Cooper, H., Meropol, N. J., ... Eisenberg, B. L. (2004). Neoadjuvant chemoradiotherapy for adenocarcinoma of the pancreas: Analysis of histopathology and outcome. International Journal of Gastrointestinal Cancer, 34(2-3), 121-127.

Neoadjuvant chemoradiotherapy for adenocarcinoma of the pancreas : Analysis of histopathology and outcome. / Sasson, Aaron R; Wetherington, R. Wesley; Hoffman, John P.; Ross, Eric A.; Cooper, Harry; Meropol, Neal J.; Freedman, Gary; Pingpank, James F.; Eisenberg, Burton L.

In: International Journal of Gastrointestinal Cancer, Vol. 34, No. 2-3, 07.10.2004, p. 121-127.

Research output: Contribution to journalReview article

Sasson, AR, Wetherington, RW, Hoffman, JP, Ross, EA, Cooper, H, Meropol, NJ, Freedman, G, Pingpank, JF & Eisenberg, BL 2004, 'Neoadjuvant chemoradiotherapy for adenocarcinoma of the pancreas: Analysis of histopathology and outcome', International Journal of Gastrointestinal Cancer, vol. 34, no. 2-3, pp. 121-127.
Sasson AR, Wetherington RW, Hoffman JP, Ross EA, Cooper H, Meropol NJ et al. Neoadjuvant chemoradiotherapy for adenocarcinoma of the pancreas: Analysis of histopathology and outcome. International Journal of Gastrointestinal Cancer. 2004 Oct 7;34(2-3):121-127.
Sasson, Aaron R ; Wetherington, R. Wesley ; Hoffman, John P. ; Ross, Eric A. ; Cooper, Harry ; Meropol, Neal J. ; Freedman, Gary ; Pingpank, James F. ; Eisenberg, Burton L. / Neoadjuvant chemoradiotherapy for adenocarcinoma of the pancreas : Analysis of histopathology and outcome. In: International Journal of Gastrointestinal Cancer. 2004 ; Vol. 34, No. 2-3. pp. 121-127.
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abstract = "To examine the histopathologic effect of neoadjuvant therapy and its impact on survival in patients with carcinoma of the pancreas, we retrospectively reviewed the records of 116 patients who underwent resections for pancreatic cancer from 1987 to 2000. Median follow-up of surviving patients was 19 mo (range 4-150 mo). Preoperative chemotherapy was administered in 61 patients (53{\%}) and consisted of 5-fluorouracil/mitomycin C in 35 patients and gemcitabine in 26 patients, given concurrently with external beam radiation (5040 cGy). All resections were performed with curative intent (98 Whipples, 11 total, 6 distal, and 1 central pancreatectomy). Histopathologic examination included an estimation of the amount of fibrosis present in the tumor specimen (expressed as the percentage of fibrosis identified relative to the amount of neoplastic cells present). The mean fibrosis level for the series was 56{\%} (range 5{\%} to 100{\%}). The administration of neoadjuvant therapy resulted in greater fibrosis (73{\%}) than no preoperative treatment (38{\%}) (p = 0.0001). Higher mean fibrosis levels were observed in patients with negative lymph nodes (p = 0.0006) and negative margins (p = 0.05). Factors associated with improved survival (log rank test) included: negative margins (p = 0.001), negative lymph nodes (p = 0.03), and use of neoadjuvant therapy (p = 0.03). Median survival in the neoadjuvant group was 23 mo vs 16 mo without preoperative therapy (p = 0.03). In conclusion, the use of neoadjuvant therapy resulted in a greater degree of fibrosis in the specimen. Patients with negative margins and negative lymph nodes had a greater amount of fibrosis present, and these were significant predictors of improved outcome. Although retrospective, this series suggests an improvement in survival in patients treated with neoadjuvant therapy.",
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