Efficacy and safety of adjuvant chemoradiation for resected pancreatic cancer with high-risk pathological feature, a single-arm prospective study

Abstract

Purpose: While adjuvant chemotherapy has been proven to significantly improve survival outcome of pancreatic ductal adenocarcinoma (PDAC) patients after surgery, whether adjuvant chemoradiation (CRT) could offer better survival and whom would benefit from adjuvant CRT remained unclear. Thus, we aimed to investigate efficacy and safety of adjuvant S-1 concurrent CRT in resected PDAC patients with defined high-risk pathological features. Methods: A single-arm, prospective cohort study was conducted in Zhongshan Hospital Fudan University from January 2013 to December 2019. Eligible patients were those with histologically confirmed PDAC and received radical resection of primary tumor and considered to have high-risk pathological features including positive resection margin, pathological T3-4N1-2M0 disease, peripancreatic fat invasion, microvascular invasion, and neural invasion. Adjuvant S-1 CRT was delivered within 3 to 24 weeks after surgery. Results: A total of 85 patients were recruited. Mean age was 61.9 (±8). Distribution of T and N stage was 27.1% for T1, 44.7% for T2, 28.2% for T3, 30.6% for N1, and 12.9% for N2. Ten patients had R1 resection. Median OS and DFS were 27.1 and 13.7 months. No fatal adverse event was recorded. Conclusion: Among resected PDAC patients with high-risk pathological features, adjuvant CRT showed promising efficacy and manageable toxicity.