Neoadjuvant treatment for borderline resectable pancreatic cancer

Abstract

Aims: Pancreatic cancer remains a lethal disease for the majority of patients despite improvements in pancreatic surgery. Recent studies have suggested a role for neoadjuvant chemo-radiotherapy in management of borderline resectable pancreatic cancer. This study aims to evaluate our early experience with neoadjuvant treatment in a pancreatic cancer centre. Methods: Retrospective analysis of prospective database was performed. Fifty-eight patients were considered for neo-adjuvant treatment between 01/01/13 and 01/01/15 after formal discussion at the multidisciplinary meeting of the Pancreatic Cancer Centre. The National Comprehensive Cancer Network (NCCN) criteria for definition of borderline resectable disease were utilised. Results: Fifty-three patients were borderline resectable according to the NCCN criteria and considered for neoadjuvant treatment. Five cases had neoadjuvant treatment despite being outside the NCCN criteria for borderline resectable disease. One patient underwent surgery directly because of inability to achieve preoperative confirmation of cancer, while two patients were considered unfit for surgery. Five patients were receiving neoadjuvant treatment at the time of the analysis and two died before any treatment. Forty-three borderline resectable patients had neoadjuvant treatment. Nine of these eventually underwent attempted resection. Three were unresectable at laparotomy. Six (14%) underwent pancreatic resection. One patient required resection of the portal vein. All the resected specimens had clear margins, 3 (50%) had minimal or no histological response, 2 had moderate and 1 complete response. Conclusions: Neoadjuvant therapy was safe and successfully administered in 94% of cases. However, a minority of treated patients were considered suitable for potential resection. Thus a neoadjuvant treatment strategy may be a useful selection tool to maximise surgical efficacy and prevent non-therapeutic surgeries. Further studies to investigate the effectiveness of neoadjuvant treatment are warranted.