A Comparison of 3 Treatment Strategies for Locally Advanced and Borderline Resectable Pancreatic Cancer

Abstract

The optimal treatment strategy for locally advanced and borderline resectable pancreatic cancer is not known. We sought to compare overall survival (OS), local control (LC), metastasis free survival (MFS), and percent of patients who were able to undergo successful surgical resection for three treatment strategies. We retrospectively reviewed 114 sequentially treated cases of locally advanced (T4) or borderline resectable (T3 but unresectable) pancreatic cancer. All patients were examined by a surgeon and felt to be unresectable at the time of diagnosis. Patients were treated with either chemotherapy alone (C), up-front chemoradiation therapy (CRT), or chemotherapy followed by chemoradiation therapy (CCRT). We calculated survival using Kaplan-Meier analysis and used log-rank analysis to compare survival between groups. A multivariate survival analysis was performed using a Cox-proportional hazards model. Median follow-up was 17.4 months. The mean age was 64.3 years. Fifty-six (49.1%) patients had locally advanced disease. Of the patients who received chemotherapy up-front, 89% received gemcitabine-based chemotherapy. During concurrent radiation therapy, patients received either 5-FU (21%), Capecitabine (72%), or Gemcitabine (7%). See the table below for a summary of the outcomes. Patients treated with CCRT experienced statistically significant improved OS and MFS compared to C alone (p = 0.019 and p = 0.041 respectively). Of the patients receiving C alone, 5/64 (7.8%) were diagnosed with distant metastases before 3 months. There was no statistically significant difference in OS or MFS between C and CRT or between CRT and CCRT. There was no statistically significant difference in LC between any of the treatment groups. There was a trend towards improved OS in patients with borderline resectable disease (p = 0.064). On multivariate analysis only younger age (p = 0.025) was associated with improved OS. There was a trend toward improved OS in patients who achieved successful surgical resection (p = 0.084). Treatment type, T stage, and N stage were not statistically significant. Treatment with CCRT is associated with improved median OS and MFS compared to C alone. This strategy may select for patients who are less likely to develop early metastases and therefore have a worse prognosis. The rate of successful surgical resection was greater than 20% in patients treated with CCRT.Oral Scientific Abstract 220; TableOutcomes by Treatment StrategyNLocally AdvancedSuccessful Surgical Resection, Borderline ResectableSuccessful Surgical Resection, Locally AdvancedMedian Survival in Months (95% CI)1-year LC (95% CI)2-year LC (95% CI)1-year MFS (95% CI)2-year MFS (95% CI)CRT2213 (59%)1/9 (11%)1/13 (8%)13.8 (10.8 to 30.5)61% (43 to 87)30% (14 to 63)59% (41 to 84)28% (14 to 57)CCRT2812 (43%)3/16 (19%)3/12 (25%)24.2 (20.1 to 46.8)85% (72 to 99)65% (48 to 89)82% (69 to 98)55% (39 to 78)C6431 (48%)6/33 (18%)0/31 (0%)16.2 (14.1 to 19.0)79% (69 to 91)40% (27 to 59)68% (58 to 81)24% (15 to 38) Open table in a new tab