Preoperative chemotherapy and radiation therapy for patients with pancreatic carcinoma without demonstrable metastatic disease: The fox chase cancer center experience

Sixty‐three patients were treated with a program of preoperative radiotherapy (RT) and two 96‐hour infusions of 5‐fluorouracil (1,000 mg/m²/day, days 2–5 and 29–32) and a single bolus of mitomycin C (10 mg/m²) on day 2. Those who had no evidence of distant disease nor local unresectability underwent pancreatic resection (16 Whipple resections, 7 total pancreatectomies, 2 distal pancreatectomies). Thirty‐eight percent of the patients had grade 3 or 4 toxicity from the chemoradioth‐erapy (CTRT). One patient died during CTRT of biliary sepsis. Operative mortality for the 25 patients with potentially curative (PC) resections was 4%. One of the four patients with palliative resection died postoperatively. Two other patients with PC resection had major postoperative morbidity. Median survival for those with PC resections was 22 months, while 5‐year survival was 20%. Recurrence was noted in 20 patients, primarily in the liver (50% of patients). Follow‐up is 25 months for 7 patients remaining alive (range 16–77 months). We conclude that this technique is relatively safe, and can produce local cancer control in most patients and prolonged survival in a few with truly localized disease. It is still unclear whether this method of treatment sequencing is any better than postoperative CTRT. © 1995 Wiley‐Liss, Inc.