Abstract
BackgroundBorderline resectable pancreatic cancer (BRPC) is a category of pancreatic cancer that is anatomically widely spread, and curative resection is uncommon with upfront surgery. Intensity-modulated radiation therapy (IMRT) is a form of radiation therapy that delivers precise radiation to a tumor while minimizing the dose to surrounding normal tissues. Here, we conducted a phase 2 study to estimate the curability and efficacy of neoadjuvant chemoradiotherapy using IMRT (NACIMRT) for patients with BRPC with arterial abutment (BRPC-A).MethodsA total of 49 BRPC-A patients were enrolled in this study and were treated at our hospital according to the study protocol between June 2013 and March 2021. The primary endpoint was microscopically margin-negative resection (R0) rates and we subsequently analyzed safety, histological effect of the treatment as well as survivals among patients with NACIMRT.ResultsTwenty-nine patients (59.2%) received pancreatectomy after NACIMRT. The R0 rate in resection patients was 93.1% and that in the whole cohort was 55.1%. No mortality was encountered. Local therapeutic effects as assessed by Evans classification showed good therapeutic effect (Grade 1, 3.4%; Grade 2a, 31.0%; Grade 2b, 48.3%; Grade 3, 3.4%; Grade 4, 3.4%). Median disease-free survival was 15.5 months. Median overall survival in the whole cohort was 35.1 months. The only independent prognostic pre-NACIMRT factor identified was serum carbohydrate antigen 19–9 (CA19-9) > 400 U/ml before NACIMRT.ConclusionsNACIMRT showed preferable outcome without significant operative morbidity for BRPC-A patients. NACIMRT contributes to good local tumor control, but a high initial serum CA19-9 implies poor prognosis even after neoadjuvant treatment.Trial RegistrationUMIN-CTR Clinical Trial: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000011776Registration number: UMIN000010113.Date of first registration: 01/03/2013,
Highlights
Borderline resectable pancreatic cancer (BRPC) is a category of pancreatic cancer that is anatomically widely spread, and curative resection is uncommon with upfront surgery
BRPC is defined as a tumor meeting any of the following criteria: BRPC with arterial abutment (BRPC-A); 1) focal tumor abutment of the superior mesenteric artery (SMA) or of the celiac axis (CA); 2) encasement of common hepatic artery (CHA) but not to the Celiac axis (CA) or proper hepatic artery (PHA); or BRPC-V; 3) involvement of the superior mesenteric vein (SMV)/ portal vein (PV) with abutment more than180°
All patients with pancreatic tumors classified as BRPC-A according to The National Comprehensive Cancer Network (NCCN) 2009 guidelines diagnosed at our hospital between June 2013 and March 2021 and who provided consent were enrolled to this study
Summary
Borderline resectable pancreatic cancer (BRPC) is a category of pancreatic cancer that is anatomically widely spread, and curative resection is uncommon with upfront surgery. BRPC is defined as a tumor meeting any of the following criteria: BRPC-A; 1) focal tumor abutment (in contact with ≤ 180° of vessel circumference) of the superior mesenteric artery (SMA) or of the celiac axis (CA); 2) encasement of common hepatic artery (CHA) but not to the CA or proper hepatic artery (PHA); or BRPC-V; 3) involvement of the superior mesenteric vein (SMV)/ portal vein (PV) with abutment more than180°. Given these definitions, BRPC-A represents a difficult entity when trying to achieve curative resection [4]. Because of the high rates of R0 after neoadjuvant therapy, patients with BRPC-A might benefit most from neoadjuvant therapy with additional radiation
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