International Journal of Pancreatology

, Volume 21, Issue 2, pp 97–104 | Cite as

Progress report: A randomized multicenter European stydy comparing adjuvant radiotherapy, 6 Mo chemotherapy, and combination therapy vs No-adjuvant treatment in resectable pancreatic cancer (ESPAC-1)

  • John P. Neoptolemos
  • Pat Baker
  • Hans Beger
  • Karl Link
  • Paolo Pederzoli
  • Claudio Bassi
  • Christos Dervenis
  • Helmut Friess
  • Markus Büchler
Original Articles


Pancreatic Cancer Pancreatic Carcinoma Pancreatic Ductal Adenocarcinoma Pancreatology Volume Advanced Pancreatic Cancer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Parkin DM, Muir CS, Whelan SL, Gao Y-T, Ferlay J, Powell J, eds.,Cancer Incidence in Five Continents. vol. VI, International Agency for Research onCancer 1992, Lyon (IARC Scientific Publications No. 120).Google Scholar
  2. 2.
    Fernandez E, Lavecchia C, Porta M, Negri M, Lucchini F, Levi F. Trends in pancreatic cancer mortality in Europe, 1955–89.Int J Cancer 1994; 57: 786–792.PubMedCrossRefGoogle Scholar
  3. 3.
    Bramhall SR, Allum WH, Jones AG, Allwood A, Cummins C, Neoptolemos JP. Treatment and survival in 13,560 patients with pancreatic cancer, and incidence of the disease in the West Midlands: an epidemiological study.Br J Surg 1995; 82: 111–115.PubMedCrossRefGoogle Scholar
  4. 4.
    Gudjonson B. Cancer of the pancreas. Fifty years of surgery.Cancer 1987; 9: 2284–2303.CrossRefGoogle Scholar
  5. 5.
    Office of Population Censuses and Surveys. Mortality Statistics: Cause: Review of the Registrar General on deaths by cause, sex and age, in England and Wales. Series DH2. No. 19, London, HMSO 1992.Google Scholar
  6. 6.
    Carter DC. Cancer of the pancreas.Gut 1990; 31: 494–496.PubMedCrossRefGoogle Scholar
  7. 7.
    Russell RCG. Surgical resection for cancer of the pancreas.Clin Gastroenterol 1990; 4: 889–916.Google Scholar
  8. 8.
    Beger HG, Link KH, Poch B, Gansauge F. Pancreatic cancer—recent progress in diagnosis and treatment, inPancreatic Cancer: Molecular and Clinical Advances. Neoptolemos JP, Lemoine NR, eds., Blackwell Science, Oxford, 1996: 227–235.Google Scholar
  9. 9.
    The Cancer Registry of Norway. Survival of cancer patients. Cases diagnosed in Norway 1968–75. Oslo: The Cancer Registry of Norway 1980.Google Scholar
  10. 10.
    Trede M, Schwall G, Saeger H-D. Survival after pancreato-duodenectomy. 188 resections without an operative mortality.Ann Surg 1990; 211: 447–458.PubMedCrossRefGoogle Scholar
  11. 11.
    Gall FP, Kessler N, Hermanek P. Surgical treatment of ductal pancreatic carcinoma.Eur J Surg Oncol 1991; 17: 173–181.PubMedGoogle Scholar
  12. 12.
    Kanyu F, Suzuki M, Imaizumi T. Whipple operation for pancreatic carcinoma: Japanese experience, inStandards in Pancreatic Surgery. Beger HG, Büchler M, Malfertheiner P, eds., Springer-Verlag, Berlin, 1993: 6467–6453.Google Scholar
  13. 13.
    Geer RJ, Brennan MF. Prognostic indicators for survival after resection of pancreatic adenocarcinoma.Am. J Surg 1993; 165: 68–72.PubMedCrossRefGoogle Scholar
  14. 14.
    Takahashi S, Ogata Y, Tsuzuki T. Combined resection of the pancreas and portal vein for pancreatic cancer.Br J Surg 1994; 81: 1190–1193.PubMedCrossRefGoogle Scholar
  15. 15.
    Allema JH, Reinders ME, Van Gulik TM, Koelemay JW, Ban Leeuwen DJ, De Wit LT, Gouma DJ, Obertop H. Prognostic factors for survival after pancreaticoduod-enectomy for patients with carcinoma of the pancreatic head region.Cancer 1995; 75: 2069–2076.PubMedCrossRefGoogle Scholar
  16. 16.
    Nitecki SS, Sarr MG, Colby TV, Van Heerden JA. Longterm survival after resection for ductal adenocarcinoma of the pancreas. Is it really improving?Ann Surg 1995; 221: 59–66.PubMedCrossRefGoogle Scholar
  17. 17.
    Yeo CJ, Cameron JL, Allemoe KD, Sitzman JV, Hruban RH, Goodman SN, Dooley WC, Coleman J, Pitt HA. Pancreaticoduodenectomy for cancer of the head of the pancreas. 201 patients.Ann Surg 1995; 221: 721–733.PubMedCrossRefGoogle Scholar
  18. 18.
    UK Pancreatic Cancer Group (UKPACA). Resection for pancreatic and periampullary tumours in 820 patients. UK survey of specialist units.Int J Pancreatol 1996, 19: 243 (abstract).Google Scholar
  19. 19.
    Neoptolemos JP, Lemoine N, Ching CH, Rhodes JM. Cancer of the pancreas and ampulla of Vater, inPremalignancy and Early Cancer in General Surgey. Fielding J, Allum W, eds., Oxford University Press, Oxford, 1996 (in press).Google Scholar
  20. 20.
    Warshaw AL, Fernandez-Del Castillo C. Pancreatic carcinoma.N Engl J Med 1992; 326: 455–465.PubMedCrossRefGoogle Scholar
  21. 21.
    Wagner M, Friess H, Büchler MW. Conservative versus radical resections of the pancreas, inPancreatic Cancer: Molecular and Clinical Advances. Neoptolemos JP, Lemoine NR, eds., Blackwell Scientific Publications, Oxford, 1996: 248–270.Google Scholar
  22. 22.
    Pedrazzoli S, Di Carlo V, Dionigi R, Michelassi F, Mosca F, Pederzoli P. Preliminary results of traditional and extended lymphadenectomy in resection of pancreatic head cancer.Digestion 1993; 54: 299 (abstract).Google Scholar
  23. 23.
    Neoptolemos JP, Bramhall S, Kerr DJ. Principles of adjuvant treatment in pancreatic cancer, inCancer of the Pancreas. Beger H, Büchler M, Schoenberg M, eds., Universitatsverlag Ulm GmbH, Ulm, Germany, 1996; 479–487.Google Scholar
  24. 24.
    Ishikawa D, Ohhigashi H, Sasaki Y, Kabuto T, Fukuda I, Furukawa H, Imaoka S, Iwanaga T. Practical usefulness of lymphatic and coMective tissue in the clearance for the carcinoma of the pancreas head.Ann Surg 1988; 208: 215–220.PubMedCrossRefGoogle Scholar
  25. 25.
    Manabe T, Oshio G, Baba N, Miyashita T, Asano N, Tamura K, Yamaki K, Nonaka A, Tobe T. Radical pancreatectomy for ductal carcinoma of the head of the pancreas.Cancer 1989; 64: 1132–1137.PubMedCrossRefGoogle Scholar
  26. 26.
    Fuhrman GM, Leach SD, Staley CA, Cusack JC, Charnsangavej C, Cleary KR, El-Naggar A, Fenoglio CJ, Lee JE, Evans DB. Rationale for en bloc vein resection in the treatment of pancreatic adenocarcinoma adherent to the superior mesenteric-portal vein confluence.Ann Surg 1996; 223: 154–162.PubMedCrossRefGoogle Scholar
  27. 27.
    Bramhall SR, Neoptolemos JP. Adjuvant treatment of pancreatic cancer, inPancreatic Cancer: Molecular and Clinical Advances. Neoptolemos JP, Lemoine NR, eds., Blackwell Scientific Publications, Oxford, 1996; 288–307.Google Scholar
  28. 28.
    Garton GR, Gunderson LL, Nagorney DM, Donohue JH, Martin JK, McIlrath DC, Cha SS. High-dose preoperative external beam and intraoperative irradiation for locally advanced pancreatic cancer.Int J Radiation Oncology Biol Phys 1993; 27: 1153–1157.Google Scholar
  29. 29.
    Hoffman JP, Weese JL, Solin LJ, Engstrom P, Agarwal P, Barber LW, Guttman MC, Utwin S, Salazar H, Eisenberg BL. A pilot study of preoperative chemoradiation for patients with localized adenocarcinoma of the pancreas.Am J Surg 1995; 169: 71–77.PubMedCrossRefGoogle Scholar
  30. 30.
    Ishikawa O, Ohigashi H, Imaoka S, Sasaki Y, Iwanaga T, Matayoshi Y, Inoue T. Is the long-term survival rate improved by preoperative irradiation prior to Whipple's procedure for adenocarcinoma of the pancreatic head?Arch Surg 1994; 129: 1075–1080.PubMedGoogle Scholar
  31. 31.
    Rich TA, Evans DB. Preoperative combined modality therapy for pancreatic cancer.World J Surg 1995; 19: 264–269.PubMedCrossRefGoogle Scholar
  32. 32.
    Staley CA, Lee JE, Cleary KR, Abbruzzese JL, Fenoglio CJ, Rich TA, Evans BD. Preoperative chemoradiation, pancreaticoduodenectomy and intraoperative radiation therapy for adenocarcinoma of the pancreatic head.Am J Surg 1996; 171: 118–125.PubMedCrossRefGoogle Scholar
  33. 33.
    Kalser MH, Ellengerg SS. Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection.Arch Surg 1985; 120: 899–903.PubMedGoogle Scholar
  34. 34.
    Bakkevold KE, Arnesjo B, Dahl O, Kambestad B. Adjuvant combination chemotherapy (AMF) following radical resection of carcinoma of the pancreas and papilla of Vater. Results of a controlled, prospective, randomized multicenter study.Eur J Cancer 1993; 29: 698–703.CrossRefGoogle Scholar
  35. 35.
    Gastrointestinal Tumor Study Group. Therapy of locally unresectable pancreatic carcinoma: A randomized comparison of high dose (6000 reds) radiation alone, moderate dose radiation (4000 reds) and high dose radiation and 5-Fluorouracil.Cancer 1981; 48: 1705–1710.CrossRefGoogle Scholar
  36. 36.
    Gastrointestinal Tumor Study Group. Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer.Cancer 1987; 59: 2006–2010.CrossRefGoogle Scholar
  37. 37.
    United Kingdom Pancreatic Cancer Group (UKPACA). Adjuvant therapy following resection of pancreatic cancer. Gut 1993; 34: 1290 (Abstract).Google Scholar
  38. 38.
    Arbuck SG. Chemotherapy for pancreatic cancer.Clin Gastroenterol 1990; 4: 953–968.Google Scholar
  39. 39.
    Cullinan S, Moertel CG, Eieand HS, Schutt AJ, Krook JE, Foley JF, Norris BD, Kardinal CG, Tschetier LK, Barlow JF. A phase III trial on the therapy of advanced pancreatic carcinoma. Evaluation of the Mallinson regimen and combined 5-Fluorouracil, doxorubicin and cisplatin.Cancer 1990; 65: 2207–2212.PubMedCrossRefGoogle Scholar
  40. 40.
    Willett CG, Lewandrowski K, Warshaw AL, Efird J, Compton CC. Resection margins in carcinoma of the head of the pancreas. Implications for radiation therapy.Ann Surg 1993, 217: 144–148.PubMedCrossRefGoogle Scholar
  41. 41.
    Schutte M, Kern SE. The molecular genetics of pancreatic adenocarcinoma.Pancreatic Cancer: Molecular and Clinical Advances. Neoptolemos JP, Lemoine NR, eds., Blackwell Scientific Publications, Oxford, 1996: 115–132.Google Scholar
  42. 42.
    Rothenberg ML, Moore MJ, Cripps MC, Andersen JS, Portenoy RK, Burris HA, Green MR, Tarassoff PG, Brown TD, Casper EJ, Storniolo A-M, Von Hoff DD. A phase II trial of gemcitabine in patients with 5-DU refractory pancreas cancer.Ann Oncology 1996; 7: 347–353.Google Scholar
  43. 43.
    Moore M, Andersen J, Burris H, Tarassoff M, Green E, Casper R, Portenoy R, Modiano M, Cripps C, Nelson R, Storniolo A, Von Hoff D. A randomized trial of gemcitabine (GEM) versus 5-FU as first-line therapy in advanced pancreatic cancer.Proc ASCO 1995; 14: 199 (abstract No. 473).Google Scholar
  44. 44.
    Bramhall S, Stamp GHH, Lemoine NR, Neoptolemos JP. The matrix metalloproteinases and their inhibitors in pancreatic cancer, inPancreatic Cancer: Molecular and Clinical Advances, Neoptolemos JP, Lemoine NR, eds., Blackwell Scientific Publications, Oxford, 1996; 69–91.Google Scholar
  45. 45.
    Evans JD, Bramhall SR, Stark A, Hinley H, Porter C, Osborne L, Daniel F, Carmichael J, Imrie C, Johnson CD, Neoptolemos JP. A phase II trial of Marimastat (BB-2516) in advanced pancreatic cancer.Int J Pancreatol 1996; 19: 218 (abstract).Google Scholar
  46. 46.
    Lemoine NR. Strategies for genetic intervention in pancreatic cancer, inPancreatic Cancer: Molecular and Clinical Advances. Neoptolemos JP, Lemoine NR, eds., Blackwell Scientific Publications, Oxford, 1996: 181–193.Google Scholar
  47. 47.
    Green NK, Youngs DJ, Searle PF, Young LS, Kerr DJ, Neoptolemos JP. Gene therapy for pancreatic cancer. Bystander killing in pancreatic cancer cells using the nitroreductase/CB1954 approach.Int J Pancreatol 1996; 19: 226 (abstract).Google Scholar

Copyright information

© Humana Press Inc 1997

Authors and Affiliations

  • John P. Neoptolemos
  • Pat Baker
  • Hans Beger
  • Karl Link
  • Paolo Pederzoli
  • Claudio Bassi
  • Christos Dervenis
  • Helmut Friess
  • Markus Büchler

There are no affiliations available

Personalised recommendations