Induction gemcitabine-based chemotherapy and neoadjuvant stereotactic body radiation therapy achieve high margin-negative resection rates for borderline resectable pancreatic cancer

Abstract

Patients with borderline resectable pancreatic cancer (BRPC) have a higher probability of undergoing margin-negative resection after completing neoadjuvant therapy. Here, we describe a novel neoadjuvant approach using induction chemotherapy followed by stereotactic body radiation therapy (SBRT) for patients with BRPC. This analysis included patients with nonmetastatic BRPC treated with neoadjuvant gemcitabine-based chemotherapy and five-fraction SBRT. Chemotherapy consisted of 3 cycles of Gemzar, Taxotere, and Xeloda. Patients were restaged to determine resectability, and nonmetastatic resectable patients underwent surgical resection. Thirty patients completed neoadjuvant treatment and were offered surgical exploration. Seventeen patients (56.7 %) reported no acute adverse effects during SBRT. No grade 3 or higher toxicity was observed from SBRT. Twenty-nine patients (96.7 %) underwent exploration. Twenty-one (95.6 %) of those who underwent pancreatic tumor resection achieved negative margins, with none requiring vessel resection. One (3.3 %) patient was resected with microscopic positive margins. Median follow-up was 15.6 months (range, 6.3–26.1 months). Median and 1-year overall survival was 20 months and 91 %, respectively. Median and 1-year progression-free survival was 14.9 months and 61 %, respectively. SBRT-based neoadjuvant therapy for BRPC is well tolerated and can result in a high rate of margin-negative tumor resection.