Role of Neoadjuvant Therapy

Potential Advantages

Neoadjuvant therapy is a potentially attractive alternative to current standard adjuvant chemoradiation for several reasons, including the following:

1. Radiation is more effective on well-oxygenated cells that have not been devascularized by surgery

2. Contamination and subsequent seeding of the peritoneum with tumor cells secondary to surgery could theoretically be reduced

3. Patients with metastatic disease on restaging following adjuvant therapy would not need to undergo definitive resection and might benefit from palliative intervention

4. The risk of delaying adjuvant therapy would be eliminated because it would be delivered in the neoadju-vant setting

There is significant published data primarily from MD Anderson Cancer Center and Fox Chase Cancer Center using chemoradiotherapy in a neoadjuvant approach for resectable PC. To date, the current data demonstrate that although neoadjuvant chemoradiotherapy can be administered safely, there is no clear advantage to this strategy when compared with postoperative therapy. in patients with marginally resectable disease, it remains to be seen whether there is a meaningful cohort of patients for whom this approach may represent an important therapeutic advantage based on "downstaging" and improved surgical outcomes.

Currently, the ECOG is planning to open a prospective randomized trial randomizing patients to intensified Gemcitabine based or Gemcitabine/5-FU/platinum based chemoradiotherapy. This trial makes an important distinction between clearly unresectable disease and potentially resectable disease, especially around the issues of partial versus complete encasement of the superior mesen-teric artery and the length of superior mesenteric vein involved by tumor at initial presentation.

Constipation Prescription

Constipation Prescription

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