Abstract
Background
Patients with borderline resectable pancreatic ductal adenocarcinoma (PDA) represent a high-risk group of patients due to tumor or patient-related characteristics. The optimal management of these patients has not been fully defined.
Materials and Methods
All patients undergoing evaluation for PDA between 2005 and 2008 were identified. Clinical, radiographic, and pathological data were retrospectively reviewed. Patients were staged as borderline resectable using the M.D. Anderson Cancer Center (MDACC) classification.
Results
A total of 170 patients with PDA were identified, 40 with borderline resectable disease. Of these, 34 borderline resectable patients (85%) completed neoadjuvant therapy and were restaged; pancreatic resection was completed in 16 patients (46%). Also, 8 patients completed 50 Gy of radiation in 28 fractions in 6 weeks, whereas 8 patients received 50 Gy in 20 fractions in 4 weeks plus chronomodulated capecitabine. An R0 resection was achieved in 12 of the 16 patients (75%). Also, 5 patients (63%) treated in 20 fractions had >90% pathologic response versus 1 (13%) treated in 28 fractions (P < .05). Borderline resectable patients completing surgery had similar survival to patients with resectable disease who underwent surgery. Patients receiving accelerated fractionation radiation had improved survival compared with patients treated with standard fractionation protocol.
Conclusions
A neoadjuvant approach to borderline resectable PDA identifies patients who are most likely to benefit from pancreatic resection. Preoperative capecitabine-based chemoradiation is an effective, well-tolerated treatment for these patients. Neoadjuvant therapy for borderline resectable PDA warrants further investigation using treatment schedules that can safely intensify irradiation dose.
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Acknowledgment
The authors thank Sara Adair for her assistance in the data analysis and Aimee Strong and Lori Fitzgerald for assistance in collection of the clinical data. Sources of financial support: NIH Research Training Grant T32 HL007849 (JBS).
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Stokes, J.B., Nolan, N.J., Stelow, E.B. et al. Preoperative Capecitabine and Concurrent Radiation for Borderline Resectable Pancreatic Cancer. Ann Surg Oncol 18, 619–627 (2011). https://doi.org/10.1245/s10434-010-1456-7
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DOI: https://doi.org/10.1245/s10434-010-1456-7