Neoadjuvant chemoradiation with IMRT in resectable and borderline resectable pancreatic cancer

Jordan Kharofa, Susan Tsai, Tracy Kelly, Clint Wood, Ben George, Paul Ritch, Lauren Wiebe, Kathleen Christians, Douglas B. Evans, Beth Erickson

Research output: Contribution to journalArticle

Abstract

Purpose: Neoadjuvant chemoradiation is an alternative to the surgery-first approach for resectable pancreatic cancer (PDA) and represents the standard of care for borderline resectable (BLR). Materials and methods: All patients with resectable and BLR PDA treated with neoadjuvant chemoradiation using IMRT between 1/2009 and 11/2011 were reviewed. Patients were treated to a customized CTV which included the primary mass and regional vessels. Results: Neoadjuvant chemoradiation was completed in 69 patients (39 BLR and 30 resectable). Induction chemotherapy was used in 32 (82%) of the 39 patients with BLR disease prior to chemoXRT. All resectable patients were treated with chemoXRT alone. Following neoadjuvant treatment, 48 (70%) of the 69 patients underwent successful pancreatic resection with 47 (98%) being margin negative (RO). In 30 of the BLR patients who had arterial abutment or SMV occlusion, 19 (63%) were surgically resected and all had RO resections. The cumulative incidence of local failure at 1 and 2 years was 2% (95% CI 0-6%) and 9% (95% CI 0.6-17%) respectively. The median overall survival for all patients, patients undergoing resection, and patients without resection were 20, 26 and 11 months respectively. Sixteen (23%) of the 69 patients are alive without disease with a median follow-up of 47 months (36-60). Conclusion: Neoadjuvant chemoXRT can facilitate a margin negative resection in patients with localized PCa.

Original languageEnglish (US)
Pages (from-to)41-46
Number of pages6
JournalRadiotherapy and Oncology
Volume113
Issue number1
DOIs
StatePublished - Jan 1 2014

Keywords

  • Borderline resectable
  • IMRT
  • Neoadjuvant chemoradiation
  • Pancreatic cancer

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

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  • Cite this

    Kharofa, J., Tsai, S., Kelly, T., Wood, C., George, B., Ritch, P., Wiebe, L., Christians, K., Evans, D. B., & Erickson, B. (2014). Neoadjuvant chemoradiation with IMRT in resectable and borderline resectable pancreatic cancer. Radiotherapy and Oncology, 113(1), 41-46. https://doi.org/10.1016/j.radonc.2014.09.010