Myroslav Yuri Lutsyk MD, Presenter: Nothing to Disclose

Fadi Mezied MD, Abstract Co-Author: Nothing to Disclose

Ron Epelbaum MD, Abstract Co-Author: Nothing to Disclose

Rahamim Ben-Yosef, Abstract Co-Author: Nothing to Disclose

Puropse/Objective: The current treatment approach for exocrine pancreatic cancer is primary surgery followed by either gemcitabine based chemotherapy or chemo-radiotherapy. Patients who had questionable complete resection undergo a resection assuming that bulky removal of the tumor will probably prolong their survival. The purpose of this study was to evaluate retrospectively whether primary chemo-radiotherapy is equivalent to R1/R2 resection (followed by adjuvant chemotherapy) in pancreatic cancer.Materials and Methods: 110 patients (74 male, 36 females, mean age of 62.8 yrs, range 38-84) with localized adenocarcinoma of pancreas, who were treated at Rambam Health Care Center in the last decade were enrolled to this study. Tumor location was in head of pancreas in 74 pts and in body/tail in the remaining 36 pts. Sixty nine pts were treated by surgery followed by gemcitabine based chemotherapy while 41 pts who their tumor found to be clinically non-resected, were treated with chemo-radiotherapy. The chemotherapy was based on combination of cisplatin and gemcitabine and only gemcitabine, in a reduced dose, during the radiation. The total dose of the radiation was 50.4 Gy, given in 1.8Gy per fraction, 5 times a week. Overall survival were explored in dependence to treatment approach and surgical margins' status.Results: Thirty seven pts underwent complete resection of the tumor (R0), 32 pts had R1/R2 and undetermined surgical margins and 43 pts had primary chemo-radiotherapy. No differences in overall survival were noted in terms of gender, tumor localization or involvement of nodes. Overall survival was higher for pts who underwent surgery, 2.132±0.25 years (CI 95%, 1.64-2.62) vs 1.2±3 0.09 years with primary chemo-radiotherapy (p<0.0001). The difference was noted after stratification of pts in accordance to margins status. Significant difference was note between R0 surgery vs primary chemo-radiotherapy and no difference between R1+R2 vs chemo-radiotherapy ( p=0.15).Conclusions: The absence of significant difference in OS between R1/R2 resection vs primary chemo-radiotherapy suggests that performance a surgery without strong evidence of R0 margin is unnecessary.

Lutsyk, M, Mezied, F, Epelbaum, R, Ben-Yosef, R, Is the Outcome Following Chemo-Radiation Equivalent to R1/R2 Resection Adjuvant Chemotherapy in Stage I-III Pancreatic Cancer?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14041656.html