HYPOTHESIS: Neoadjuvant therapy has the potential to induce regression of high-risk, locally advanced @entity5 and render them resectable. Preoperative chemoradiotherapy is proposed as a testable treatment concept for locally advanced @entity788 . DESIGN: Fourteen @entity1 (8 @entity1 , 6 @entity1 ) with locally advanced @entity788 were surgically explored to exclude distant spread of disease, to perform bypass of biliary and/or @entity356 , and to provide a jejunostomy feeding tube for long-term nutritional support. A course of chemotherapy with @entity1487 and @entity900 plus radiotherapy was then initiated. Reexploration and resection were planned subsequent to neoadjuvant therapy. MAIN OUTCOME MEASURES: Tumor regression and survival. INTERVENTIONS: Surgically staged @entity1 with locally advanced @entity788 were treated by preoperative chemotherapy with bolus @entity1487 , 400 mg/m2, on days 1 through 3 and 28 through 30 accompanied by a 3-day infusion of @entity900 , 25 mg m2, on days 1 through 3 and 28 through 30 and concurrent radiotherapy, 45 Gy. Enteral nutritional support was maintained via jejunostomy tube. RESULTS: Of 14 @entity1 who enrolled in the protocol and were initially surgically explored, 3 refused the second operation and 11 were reexplored; 2 showed @entity74 and were unresectable and 9 (81%) had definitive resection. Surgical pathologic stages of the resected @entity1 were: Ib (2 @entity1 ), II (2 @entity1 ), and III (5 @entity1 ). Pancreatic resection included standard Whipple resection in 1 @entity1 , resection of body and neck in 1 @entity1 , and extended resection in 6 @entity1 (portal vein resection in 6, arterial resection in 4). One @entity1 who was considered too frail for resection had core biopsies of the pancreatic head, node dissection, and an interstitial implant of the @entity5 head. Pathologic response: 2 @entity1 had apparent complete pathologic response; 1 @entity1 had no @entity5 in the pancreatectomy specimen, the other @entity1 who had an iridium 192 interstitial implant had normal core biopsies of the pancreatic head. Five @entity1 had minimal @entity5 in the resected pancreas or microscopic foci only with extensive @entity82 , and 2 @entity1 had fully viable @entity5 . Lymph node downstaging occurred in 2 of 4 @entity1 who had positive peripancreatic nodes at the initial surgical staging. There was 1 postoperative @entity204 at 10 days. @entity295 , prolonged ileus, and failure to thrive were major complications. In the definitive surgery group the median survival was 19 months after beginning chemoradiotherapy and 16 months after definitive surgery. The absolute 5-year survival was 11% of 9 @entity1 , 1 is surviving 96 months (with no evidence of disease) after chemoradiotherapy and extended pancreatic resection including resection of the superior mesenteric artery and the portal vein for @entity5 . In the nonresected group the mean survival was 9 months (survival range, 7-12 months) after initiation of chemoradiotherapy. CONCLUSION: A pilot study of preoperative chemoradiotherapy with infusional @entity900 and radiation induced a high rate of clinical pathologic response in @entity1 with locally advanced @entity788 and merits further study in these high-risk @entity1 .

Preoperative chemotherapy, radiotherapy, and surgical resection of locally advanced XXXX .

@entity1 :: ('9606', 'Species') :: ['women', 'patients', 'patient', 'men'] @entity788 :: ('MESH:D010190', 'Disease') :: ['pancreatic cancer'] @entity82 :: ('MESH:D005355', 'Disease') :: ['fibrosis'] @entity295 :: ('MESH:D018805', 'Disease') :: ['Sepsis'] @entity5 :: ('MESH:D009369', 'Disease') :: ['stage III cancer', 'residual cancer', 'tumorous', 'cancers'] @entity900 :: ('MESH:D002945', 'Chemical') :: ['cisplatin'] @entity74 :: ('MESH:D030342', 'Disease') :: ['progressive disease'] @entity204 :: ('MESH:D003643', 'Disease') :: ['death'] @entity356 :: ('MESH:D013274', 'Disease') :: ['gastric obstruction'] @entity1487 :: ('MESH:D005472', 'Chemical') :: ['fluorouracil']
@entity788 :: (MESH:D010190,Disease) :: ['pancreatic cancer']
