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Neoadjuvant chemoradiation for non‐metastatic pancreatic cancer increases margin‐negative and node‐negative rates at resection
Author(s) -
Berriochoa Camille A.,
AbdelWahab May,
Leyrer Charles M.,
Khorana Alok,
Matthew Walsh R.,
Kumar Aryavarta M. S.
Publication year - 2017
Publication title -
journal of digestive diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 51
eISSN - 1751-2980
pISSN - 1751-2972
DOI - 10.1111/1751-2980.12551
Subject(s) - medicine , oncology , pancreatic cancer , neoadjuvant therapy , margin (machine learning) , resection , cancer , surgery , breast cancer , machine learning , computer science
OBJECTIVE To compare neoadjuvant to adjuvant chemoradiation in non‐metastatic pancreatic cancer patients. METHODS Single‐institution data were obtained for patients with non‐metastatic pancreatic cancer treated with concurrent chemoradiation from 2011 to 2014. Univariate analyses were performed to evaluate clinical and pathological outcomes. RESULTS Fifty‐two well‐matched patients were enrolled (21 underwent neoadjuvant chemoradiation, 11 with adjuvant chemoradiation and 20 in the definitive group). Median tumor size was 2.6 cm pretreatment and 2.5 cm after neoadjuvant chemoradiation but 3.2 cm on pathology, with a treatment effect in 95.2% of specimens. Clinical node positivity at diagnosis for neoadjuvant and adjuvant chemoradiation groups was similar (28.6% vs 27.3%, P = 0.12). Of the 36 neoadjuvant patients, 21 (58.3%) underwent complete resection. In the neoadjuvant vs adjuvant chemoradiation groups, positive margins were decreased (4.8% vs 63.6%, P < 0.001), as was pathological nodal positivity (23.8% vs 90.9%, P < 0.001). After a median follow‐up of 13.3 months, locoregional control for neoadjuvant and adjuvant chemoradiation was 7.7 and 7.2 months, respectively ( P = 0.12) and the definitive group was 1.2 months ( P = 0.014 compared with the surgical cohort). One‐year overall survival was better with neoadjuvant than with adjuvant chemoradiation but this was not significant (94% vs 82%, P = 0.20); 1‐year survival for the definitive group was 59% ( P = 0.03 compared with the surgical cohort). CONCLUSIONS Neoadjuvant chemoradiation remains a promising approach for non‐metastatic pancreatic cancer for improving resectability and pathological and clinical findings. Computed tomography may not fully demonstrate the effectiveness of neoadjuvant treatment.