Neoadjuvant Gemcitabine-based Accelerated Hyperfractionation Chemoradiotherapy for Patients with Borderline Resectable Pancreatic Adenocarcinoma

作者：Takeda Yutaka^*; Nakamori Shoji; Eguchi Hidetoshi; Kobayashi Shogo; Marubashi Shigeru; Tanemura Masahiro; Konishi Koji; Yoshioka Yasuo; Umeshita Koji; Mori Masaki; Doki Yuichiro; Nagano Hiroaki

来源：Japanese Journal of Clinical Oncology, 2014, 44(12): 1172-1180.

DOI：10.1093/jjco/hyu143

• pancreatic cancer
• gemcitabine
• neoadjuvant

We report the response to pre-operative gemcitabine-based chemoradiotherapy for pancreatic adenocarcinoma.
Thirty-five consecutive patients with borderline resectable pancreatic adenocarcinoma of UICC Stage II or III with portal vein invasion or tumor abutment of artery received radiotherapy (twice daily fractions of 1.5 Gy, 5 days/week, total dose: 36 Gy; 30 Gy for Phase I Level 1) with weekly intravenous infusions of gemcitabine (400, 600 and 800 mg/m(2)) at Days 1 and 8 for Phase I and 800 mg/m(2) for Phase II. Restaging was repeated after completion of chemoradiotherapy.
Twenty-six of the 35 (74.3%) patients underwent resection. The dose-limiting toxicities were Grade 4 neutropenia and thrombocytopenia. The recommended regimen was total radiation dose of 36 Gy with gemcitabine 800 mg/m(2). Surgical resection was conducted in 11 of the 15 (73.3%) patients in Phase I study and 15 of the 20 (75.0%) in Phase II. After recommended dose chemoradiotherapy and surgical resection, the median disease-free survival was 17.4 months (5-year survival rate = 14.3%). The median overall survival time and 5-year survival rate were 41.2 months and 28.6%, respectively, for the 21 patients who underwent resection and 10.0 months and 0%, respectively, for those 5 who did not (P = 0.004).
Our pre-operative gemcitabine-based chemoradiotherapy was well tolerated and safe.

• 出版日期2014-12