Preoperative chemoradiotherapy, pancreaticoduodenectomy, and external- beam intraoperative radiotherapy for pancreatic adenocarcinoma: The M.D. Anderson experience

FOR PATIENTS undergoing potentially curative pancreaticoduodenectomy, reported 5-year survival rates range from 10%-25%. Recurrence in the bed of the resected pancreas has traditionally represented the most common initial site of treatment failure. In this report, we describe the M. D. Anderson experience with aggressive multimodal therapy as a means to attain improved locoregional control in patients with pancreatic adenocarcinoma. This approach includes preoperative chemoradiotherapy, extended pancreaticoduodenectomy, and intraoperative radiotherapy. When necessary, resection and reconstruction of the superior mesenteric-portal venous confluence is also performed. This multimodal regimen has resulted in a dramatic shift away from local recurrence as the dominant mode of treatment failure. Although locoregional tumor control is clearly attainable using this approach, improvements in overall survival will likely await more effective systemic therapies.