PD-0032 Preoperative Chemoradiation for Resectable Adenocarcinoma of the Pancreas (ISRCTN 78805636): Pattern of Recurrence.

ABSTRACT Introduction Standard treatment for resectable pancreatic carcinoma is primary surgery, and most patients die of recurrent cancer. Chemoradiation is used to treat locally unresectable pancreatic cancer which is meant to stop local progress at least for a while. Neoadjuvant chemoradiation was introduced prior to surgery in locally resectable cancer in this trial. The local effect of chemoradiation and its influence on resection rates and recurrence patterns after tumor resection is examined now. Methods Patients with histologically proven ductal adenocarcinoma of the pancreatic head encircling peripancreatic vessels for Results Between 01.06.2003 and 31.12.2009, 73 patients were randomised in 8 centres (A n = 37, B n = 36). Due to slow recruitment the trial was closed early (planned n = 254). By 09.03.2012 data of 68 patients (A/B n = 34) could be evaluated, 3 patients withdrew consent (A/B n = 2/1), 1 centre did not sent data (A/B n = 1). Tumor resection was performed in 24 patients (A) and in 20 patients (B) by intention-to-treat-analysis. Explorative laparotomy revealed locally unresectable tumor in 6 patients (A/B n = 4/2) and distant metastasis in 13 patients (A/B n = 5/8). By now 20 patients (A) and 16 patients (B) had recurrence of cancer: 3 patients (A) had residual tumor and/or residual filiae and died within 7 months, 1 patient (B) had residual tumor and died 5 months after randomization. 6 patients (A/B n = 5/1) had local recurrence first, whereas 15 patients (A/B n = 7/8) had distant metastases as primary recurrence localization. 9 patients (A/B n = 4/5) had local recurrence and distant metastases diagnosed simultaneously. The localization of cancer recurrence was not known in 2 patients (A/B n = 1/1). There was no significant difference in median time from randomization until tumor progression with 10 months in group A and 9 months in group B (p = 0.4) after tumor resection. Even though median time to local recurrence was delayed after chemoradiation with 7 months in group A and 10 months in group B. Conclusion In this trial the pattern of local and distant recurrence of pancreatic cancer after tumor resection was not significantly different with and without preoperative chemoradiation treatment. But this might be due to low patient numbers because of early stopping the trial for slow recruitment.