Phase II study of induction chemotherapy followed by chemoradiotherapy in patients with borderline resectable and unresectable locally advanced pancreatic cancer

Abstract

There is not a clear consensus regarding the optimal treatment of locally advanced pancreatic disease. There is a potential role for neoadjuvant therapy to treat micrometastatic disease with chemotherapy, as well as for the treatment of local disease with radiotherapy. We evaluated the safety and efficacy of induction chemotherapy with oxaliplatin and gemcitabine followed by a high weekly dose of gemcitabine concurrent to radiation therapy in patients with borderline resectable and unresectable locally advanced pancreatic cancer. In our study, 41 patients with pancreatic cancer were evaluated. In all cases an accurate pre-treatment staging was performed. Patients with evidence of metastatic disease were excluded, and thus a total of 34 patients were consequently enrolled. Of these, twenty-seven patients (80%) had locally advanced unresectable tumours, seven patients (20%) had borderline resectable disease. This protocol treatment represents a well-tolerated promising approach. Fifteen patients (55.5%) underwent surgical radical resection. With a median follow-up of 20 months, the median PFS and OS were 20 months and 19.2 months, respectively. The median OS for borderline resectable patients was 21.5 months compared with 14 months for unresectable patients (p = 0.3). Continued optimization in multimodality therapy and an accurate patient selection remain crucial points for the appropriate treatment of these patients.

CA19.9 Serum Level Predicts Lymph-Nodes Status in Resectable Pancreatic Ductal Adenocarcinoma: A Retrospective Single-Center Analysis

“…Surgical resection represents the optimal treatment for patients affected by PDAC (2,3). Unfortunately, due to the advanced stage of the disease at first diagnosis, mostly related to the presence of distant metastases or local vascular invasion, only a minority of PDAC patients are eligible for upfront surgery (4).…”

Dose-escalated radiotherapy for unresectable or locally recurrent pancreatic cancer: Dose volume analysis, toxicity and outcome of 28 consecutive patients

“…In a phase-I/II dose escalation trial Ben-Josef and colleagues reported a median overall survival time of 14.8 months with most patients of the study receiving 55 Gy prescribed dose [18]. Another Phase-II study with induction chemotherapy followed by radiochemotherapy up to 59.4 Gy total radiation dose reported a median overall survival time of 14 months in unresectable patients [19]. Despite further dose escalation, permanent local tumor control is still unsatisfactory with in-field recurrences in most cases.…”

Advances in the management of pancreatic ductal adenocarcinoma

“…40 However, several studies that evaluated neoadjuvant approaches have since challenged this convention, showing conversion to resectability and similar outcomes to upfront resectable PDAC. [41][42][43][44] A 2019 meta-analysis involving 313 patients with borderline resectable pancreatic cancer who received FOLFIRINOX (24 studies: 16 retrospective and 8 prospective) reported a median OS of 22.2 months. 45 Imaging after neoadjuvant treatment will not always show a radiographic response.…”