Journal Article

Clinical Impact of Neoadjuvant Chemotherapy and Chemoradiotherapy in Borderline Resectable Pancreatic Cancer: Analysis of 884 Patients at Facilities Specializing in Pancreatic Surgery

Takishita, Chie, Ohta, Tetsuo, Murakami, Yoshiaki, Hijikata, Yosuke, Endo, Itaru, Sho, Masayuki, Isaji, Shuji, Yamaue, Hiroki, Sahara, Yatsuka, Suzuki, Shuji, Katsumata, Kenji, Fujii, Tsutomu, Nagakawa, Yuichi, Nagakawa, Takukazu, Tsuchida, Akihiko, Unno, Michiaki, Kawachi, Shigeyuki, Hosokawa, Yuichi, Satoi, Sohei

2019

Overview

Background The efficacy of neoadjuvant therapy (NAT), including neoadjuvant chemotherapy (NAC) and neoadjuvant chemo-radiotherapy (NACRT), for patients with borderline resectable pancreatic cancer (BRPC) has not been elucidated. This study aimed to clarify the efficacy of NAC and NACRT for patients with BRPC. Methods The study analyzed the treatment outcomes of 884 patients treated for BRPC from 2011 to 2013. Treatment results were compared between upfront surgery and NAT and between NAC and NACRT using propensity score-matching analysis. Overall survival (OS) was calculated via intention-to-treat analyses. Results The overall resection rates for the patients who underwent NAT were significantly lower than for the patients who underwent upfront surgery (75.1% vs 93.3%; p  < 0.001). However, the R0 resection rate was significantly higher for NAT than for upfront surgery ( p  < 0.001). Additionally, the OS for the patients who received NAT was significantly longer than for those who underwent upfront surgery (median survival time [MST], 25.7 vs 19.0 months; p  = 0.015). The lymph node rate for the patients with NACRT was significantly lower than for those who underwent NAC ( p  < 0.001). However, the resection rate for the NACRT cases was significantly lower than for the NAC cases ( p  = 0.041). The local recurrence rate for the NACRT cases was significantly lower than for the NAC cases ( p  = 0.002). However, OS did not differ significantly between NAC and NACRT (MST, 29.2 vs 22.5 months; p  = 0.130). Conclusions The study showed that NAT has potential benefit for patients with BRPC. Compared with NAC, NACRT decreased the rates for lymph node metastasis and local recurrence but did not improve the prognosis.

• Publisher: Springer International Publishing,Springer Nature B.V
• Subject: Biopsy / Chemoradiotherapy / CHEMOTHERAPY / COMBINED THERAPY / LYMPH NODES / Lymphatic system / Medical prognosis / Medicine / Medicine & Public Health / METASTASES / NEOPLASMS / Oncology / PANCREAS / Pancreatic cancer / Pancreatic Tumors / PATIENTS / Radiation therapy / RADIOLOGY AND NUCLEAR MEDICINE / RADIOTHERAPY / SURGERY / Surgical Oncology / Survival