Abstract
The use of neoadjuvant chemotherapy or radiation for borderline resectable pancreatic adenocarcinoma (BL‐PDAC) is increasing. However, the impact of neoadjuvant chemotherapy and radiation therapy on the outcome of BL‐PDAC remains to be elucidated. We performed a retrospective analysis of 93 consecutive patients who were diagnosed with BL‐PDAC and primarily followed at Johns Hopkins Hospital between February 2007 and December 2012. Among 93 patients, 62% received upfront neoadjuvant chemotherapy followed by chemoradiation, whereas 20% received neoadjuvant chemoradiation alone and 15% neoadjuvant chemotherapy alone. Resectability following all neoadjuvant therapy was 44%. Patients who underwent resection with a curative intent had a median overall survival (mOS) of 25.8 months, whereas those who did not undergo surgery had a mOS of 11.9 months. However, resectability and overall survival were not significantly different between the three types of neoadjuvant therapy. Nevertheless, 22% (95% CI, 0.13–0.36) of the 58 patients who received upfront chemotherapy followed by chemoradiation remained alive for a minimum of 48 months compared to none of the 19 patients who received upfront chemoradiation. Among patients who underwent curative surgical resection, 32% (95% CI, 0.19–0.55) of those who received upfront chemotherapy remained disease free at least 48 months following surgical resection, whereas none of the eight patients who received upfront chemoradiation remained disease free beyond 24 months following surgical resection. Neoadjuvant therapy with upfront chemotherapy may result in long‐term survival in a subpopulation of patients with BL‐PDAC.
Highlights
MethodsSurgery remains the only potentially curative treatment for pancreatic ductal adenocarcinoma (PDAC)
The remaining six patients (7%) did not have celiac axis (CA) 19-9 levels recorded at the initial visit
Approximately 32% of patients who received upfront chemotherapy remained disease-free at a minimum of 48 months following surgical resection, whereas none of the eight patients who received upfront chemoradiation remained disease-free beyond 24 months following surgical resection (Fig. 3B). These results suggest that neoadjuvant therapy with upfront chemotherapy may result in extended recurrence-free survival in a subpopulation of BL-PDACs following surgical resection
Summary
MethodsSurgery remains the only potentially curative treatment for pancreatic ductal adenocarcinoma (PDAC). Only 15–20% of patients with newly diagnosed PDAC are eligible for potentially curative surgical resection [1, 2]. Increasing the proportion of patients who are eligible for curative resection is a potential strategy to improve the overall outcomes of PDAC. Among the patients who are potential surgical candidates, some are considered to have a “borderline resectable PDAC (BL-P DAC).”. This classification was broadly accepted at the consensus conference of the American Hepato-Pancreato- Biliary Association (AHPBA), the Society of Surgical Oncology (SSO), and the Society of the Surgery of Alimentary Tract (SSAT) in 2009 [3], and has been incorporated into the National Comprehensive Cancer Network (NCCN) guidelines [4] to include the following scenarios of blood vessel involvement:
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