Preoperative combined modality therapy for pancreatic cancer.

Combined modality therapy can be administered prior to surgical resection for patients with operable pancreatic cancer. One important criteria used to select patients for this treatment sequence is the absence of arterial vascular encasement by tumor on thin-section CT scanning; the absence of peritoneal seeding on surgical staging or laparoscopy has been another important parameter used in identifying patients with "localized" disease. Preoperative treatment with infusional chemoradiation uses multiple fields of irradiation delivering a dose of 50.4 Gy in 28 fractions over 5 1/2 weeks. This is done in conjunction with a continuous infusion of 5-fluorouracil intravenously at a dosage of 300 mg/m2/day with each day of radiotherapy treatment. The initial results of this protocol indicate acceptable toxicity and no evidence of increased perioperative morbidity or mortality compared to series using operation alone. We conclude that nearly all patients eligible for this combined modality treatment approach complete therapy as prescribed with acceptable toxicity.