Abstract
BackgroundWe aimed to evaluate the efficacy and safety of 5-fluorouracil-based neoadjuvant chemoradiotherapy (NACRT) in patients with resectable/borderline resectable pancreatic ductal adenocarcinoma (PDAC).MethodsThis retrospective study investigated the clinicopathological features and > 5-year survival of patients with T3/T4 PDAC who underwent NACRT at our institute between 2003 and 2012.ResultsSeventeen resectable and eight borderline resectable patients were included. The protocol treatment completion and resection rates were 92.0% and 68.0%, respectively. Two patients failed to complete chemotherapy owing to cholangitis or anorexia. Common grade 3 toxicities included anorexia (12%), neutropenia (4%), thrombocytopenia (4%), anemia (4%), and leukopenia (12%). Pathologically negative margins were achieved in 94.1% of patients who underwent pancreatectomy. Pathological response according to Evans’ classification was grade IIA in 10 patients (58.8%), IIB in 5 patients (29.4%), and IV in 2 patients (11.8%). Postoperative pancreatic fistulas were observed in four patients (23.5%), delayed gastric emptying in one patient (5.9%), and other operative morbidities in four patients (23.5%). The 1-, 2-, 5-, and 10-year overall survival rates were 73.9%, 60.9%, 60.9%, and 39.1%, respectively (median follow-up period, 80.3 months).ConclusionsNACRT is tolerable and beneficial for resectable/borderline resectable PDAC, even in the long-term.
Highlights
Pancreatic cancer, especially pancreatic ductal adenocarcinoma (PDAC), is a devastating disease that is associated with poor prognosis and low resectability rates (15.0– 20.0%) [1]
One rationale for using neoadjuvant chemotherapy or neoadjuvant chemoradiotherapy (NACRT) is to achieve negative resection margins (R0) because survival rates are poor in patients with positive resection margins (R1/R2)
NACRT was selectively administered to a limited number of patients with T3/T4 PDAC according to the TumorNode-Metastasis classification, seventh edition, who agreed with this treatment
Summary
Pancreatic cancer, especially pancreatic ductal adenocarcinoma (PDAC), is a devastating disease that is associated with poor prognosis and low resectability rates (15.0– 20.0%) [1]. One rationale for using neoadjuvant chemotherapy or neoadjuvant chemoradiotherapy (NACRT) is to achieve negative resection margins (R0) because survival rates are poor in patients with positive resection margins (R1/R2). Another reason is its more effective delivery, compared to. The proposed benefits of chemoradiotherapy in pancreatic cancer are local disease control and improved rates of complete resection [6,7,8]. We aimed to evaluate the efficacy and safety of 5-fluorouracil-based neoadjuvant chemoradiotherapy (NACRT) in patients with resectable/borderline resectable pancreatic ductal adenocarcinoma (PDAC)
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