Annals of Surgical Oncology

, Volume 17, Issue 1, pp 194–205 | Cite as

A Systematic Review of Resectability and Survival After Concurrent Chemoradiation in Primarily Unresectable Pancreatic Cancer

  • Alessio G. Morganti
  • Mariangela Massaccesi
  • Giuseppe La Torre
  • Luciana Caravatta
  • Adele Piscopo
  • Rosa Tambaro
  • Luigi Sofo
  • Giuseppina Sallustio
  • Marcello Ingrosso
  • Gabriella Macchia
  • Francesco Deodato
  • Vincenzo Picardi
  • Edy Ippolito
  • Numa Cellini
  • Vincenzo Valentini
Radiation Oncology

Abstract

Purpose

The objective of this study was to determine the effect on resection rate and survival of neoadjuvant chemoradiotherapy for primarily unresectable locally advanced pancreatic carcinoma.

Methods

A systematic review of recently published literature was performed. Resection rates and survival data were derived from reports published from 2000 onwards. Only recent studies, based on radiotherapy with standard dose and fractionation, have been analyzed.

Results

Thirteen studies with a total of 510 patients met selection criteria. A resection rate of 8.3–64.2% was reported (median, 26.5%). Of the operated patients, 57.1–100% (median, 87.5%) had R0 tumor resection. Most papers reported occasional pathological complete responses (CR, 3.0–8.8%). When outcome in all patients was considered, median survival ranged from 9 to 23 (median, 13.3) months, comparing favorably with literature data based on concurrent chemoradiation alone (range, 8.6–13 months). Surprisingly, in patients with unresectable tumor at presentation, median survival after surgery ranged from 16.4 to 32.3 (median, 23.6) months.

Conclusions

The finding of a high proportion of R0 resection among all resections performed confirms the activity of neoadjuvant radiochemotherapy and should not be neglected. Based on these data, patients with unresectable pancreatic cancer without disease progression after chemoradiotherapy should be considered for radical surgery.

Keywords

Pancreatic Cancer Gemcitabine Resection Rate Advanced Pancreatic Cancer Resected Patient 

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Copyright information

© Society of Surgical Oncology 2009

Authors and Affiliations

  • Alessio G. Morganti
    • 1
    • 2
  • Mariangela Massaccesi
    • 1
  • Giuseppe La Torre
    • 3
  • Luciana Caravatta
    • 1
  • Adele Piscopo
    • 1
  • Rosa Tambaro
    • 2
  • Luigi Sofo
    • 4
  • Giuseppina Sallustio
    • 5
  • Marcello Ingrosso
    • 6
  • Gabriella Macchia
    • 1
  • Francesco Deodato
    • 1
  • Vincenzo Picardi
    • 1
  • Edy Ippolito
    • 1
  • Numa Cellini
    • 7
  • Vincenzo Valentini
    • 7
  1. 1.Department of Radiation Oncology, “John Paul II” Center for High Technology Research and Education in Biomedical SciencesCatholic UniversityCampobassoItaly
  2. 2.Department of Palliative Therapies, “John Paul II” Center for High Technology Research and Education in Biomedical SciencesCatholic UniversityCampobassoItaly
  3. 3.Unit of Clinical Medicine and Public Health, Sapienza University of RomeRomeItaly
  4. 4.Department of Surgery, “John Paul II” Center for High Technology Research and Education in Biomedical SciencesCatholic UniversityCampobassoItaly
  5. 5.Department of Radiology, “John Paul II” Center for High Technology Research and Education in Biomedical SciencesCatholic UniversityCampobassoItaly
  6. 6.Department of Endoscopy, “John Paul II” Center for High Technology Research and Education in Biomedical SciencesCatholic UniversityCampobassoItaly
  7. 7.Department of RadiotherapyPoliclinico Universitario “A. Gemelli,” Catholic UniversityRomeItaly

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