Treatment efficacy analysis of preoperative neoadjuvant chemoradiation therapy in borderline resectable pancreatic cancer

Abstract

Background : Borderline resectable pancreatic cancer (BRPC) is defined as the presence of tumor extension to the adjacent visceral arteries (SMA, celiac axis, hepatic artery) or veins (SMV, PV) without distant metastasis. Although, margin-negative resection is the only modality to cure pancreatic cancer, BRPC patients have the risk of incomplete curative resection. In addition, surgical outcome of BRPC is thought be poor because of the increased complexity of surgery and advanced nature of the tumor even though margin-negative resection was done successfully. Nowadays, several approaches with neoadjuvant chemoradiation therapy for BRPC patients were being developed. The aim of this study is to evaluate whether neoadjuvant chemoradiation therapy in BRPC patients could improve survival.Patient and Method : Total 338 pancreatic cancer patients were treated with operation in a single tertiary medical center in Korea between January 2002 and December 2011. Of these, 51 patients (15.1%) had BRPC. 30 (8.9%) patients underwent neoadjuvant chemoradiation therapy prior to surgery (CCRT (+) group) and 21 (6.2%) patients underwent surgery without any neoadjuvant treatment (CCRT (−) group). Patient outcomes of two groups were evaluated retrospectively. Result : Overall survival of all patients was 26.6 months (median). Overall survival in the two groups was significantly different. (45.0 months in CCRT (+) group and 23.5 months in CCRT (-) group; p=0.045). CCRT (+) group showed lower recurrent rate (50.0% vs. 81.0%; p=0.024) and longer median disease-free survival period (21.0 months vs. 10.6 months; p=0.004) than CCRT (-) group. Conclusion : Neoadjuvant chemoradiation therapy seems to show superior patient outcomes in BRPC. Further clinical trials might be needed about the chemotherapeutic agent and the modality of radiotherapy.