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Neoadjuvant chemoradiation with IMRT in resectable and borderline resectable pancreatic cancer. Radiother Oncol 2014 Oct;113(1):41-6

Date

12/03/2014

Pubmed ID

25443499

Pubmed Central ID

PMC4530020

DOI

10.1016/j.radonc.2014.09.010

Scopus ID

2-s2.0-84922745297   34 Citations

Abstract

PURPOSE: Neoadjuvant chemoradiation is an alternative to the surgery-first approach for resectable pancreatic cancer (PDA) and represents the standard of care for borderline resectable (BLR).

MATERIALS AND METHODS: All patients with resectable and BLR PDA treated with neoadjuvant chemoradiation using IMRT between 1/2009 and 11/2011 were reviewed. Patients were treated to a customized CTV which included the primary mass and regional vessels.

RESULTS: Neoadjuvant chemoradiation was completed in 69 patients (39 BLR and 30 resectable). Induction chemotherapy was used in 32 (82%) of the 39 patients with BLR disease prior to chemoXRT. All resectable patients were treated with chemoXRT alone. Following neoadjuvant treatment, 48 (70%) of the 69 patients underwent successful pancreatic resection with 47 (98%) being margin negative (RO). In 30 of the BLR patients who had arterial abutment or SMV occlusion, 19 (63%) were surgically resected and all had RO resections. The cumulative incidence of local failure at 1 and 2 years was 2% (95% CI 0-6%) and 9% (95% CI 0.6-17%) respectively. The median overall survival for all patients, patients undergoing resection, and patients without resection were 20, 26 and 11 months respectively. Sixteen (23%) of the 69 patients are alive without disease with a median follow-up of 47 months (36-60).

CONCLUSION: Neoadjuvant chemoXRT can facilitate a margin negative resection in patients with localized PCa.

Author List

Kharofa J, Tsai S, Kelly T, Wood C, George B, Ritch P, Wiebe L, Christians K, Evans DB, Erickson B

Authors

Kathleen K. Christians MD Professor in the Surgery department at Medical College of Wisconsin
Beth A. Erickson MD Professor in the Radiation Oncology department at Medical College of Wisconsin
Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin
Ben George MD Associate Professor in the Medicine department at Medical College of Wisconsin
Tracy R. Kelly MD Associate Professor in the Radiation Oncology department at Medical College of Wisconsin
Susan Tsai MD Associate Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adenocarcinoma
Adult
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols
Chemoradiotherapy, Adjuvant
Female
Humans
Male
Middle Aged
Neoadjuvant Therapy
Pancreatic Neoplasms
Radiotherapy, Intensity-Modulated
Retrospective Studies
Treatment Outcome