Adjuvant Chemotherapy is Associated to Good Survival in Patients Underwent Extended Pancreaticoduodenectomy for Pancreatic Cancer
Iacono C1, Cantore M3, Ruzzenente A1, Verlato G2, Facci E1, Zugni C1, Campagnaro T1, Mambrini A3, Fontana M1, Pachera S1, Guglielmi A1
Departments of 1Surgery, and 2Medicine and Public Health, University of Verona. Verona, Italy. 3Department of Oncology, Massa Carrara Hospital. Massa, Carrara, Italy
ABSTRACT
Context Several types of adjuvant treatments have been proposed to improve survival in pancreatic cancer after surgery. Aim The present study aims at evaluating whether survival is increased in patients undergoing adjuvant chemotherapy (ADJCT) with respect to patients undergoing surgery alone. The rational for this treatment is to combine local control of the disease, achieved by extended pancreaticoduodenectomy (EPD), with control of distant metastases, achieved by ADJCT. Patients and methods 84 patients underwent EPD from January 1994 to October 2005; 54 patients with ductal pancreatic carcinoma were included in this study. Twenty patients received ADJCT while 34 receive surgery alone. Fifteen of 20 patients received intra-arterial chemotherapy employing FLEC regimen (5-fluoruracil 750 mg/m2, leucovorin 75 mg/m2, epirubicin 45 mg/m2, carboplatin 225 mg/m2 administered every three weeks in to coeliac axis for three cycles), in 7 cases followed by systemic gemcitabine (at the dosage of 1 mg/m2 on days 1, 8, 15 every 4 weeks for three months); five of 20 patients received others type of adjuvant treatments. Results The two groups were comparable for gender, age, grading, tumor size, stage, N status, and R0 or R1 resection. Median follow-up time was 16,5 months. The overall mean and median survival was 40.9 months and 18 months (range: 4-136 months), respectively, with actuarial 1-, 3- and 5-year survival rates of 70.4, 36.9 and 18.9%, respectively. ADJCT was well tolerated, with only one case of grade 3 nausea/vomiting, one patient had grade 3 anemia and leukopenia, and two patients had grade 3 thrombocytopenia. Significant difference in mean survival (47 vs. 30 months, P<0.05) and actuarial 5-year survival rates (52 vs. 10%, P<0.05) was seen in those who received ADJCT. ADJCT significantly influenced distant recurrence rate (45% vs. 85%, P<0.05) but it did not reduced local recurrence rate (20% vs. 35%, P=0.2). Conclusions ADJCT is associated with long-term survival and decreased distant recurrence rates in patients with pancreatic cancers who have undergone EPD.
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