Author:
Masui Toshihiko,Nagai Kazuyuki,Anazawa Takayuki,Sato Asahi,Uchida Yuichiro,Nakano Kenzo,Yogo Akitada,Kaneda Akihiro,Nakamura Naoto,Yoshimura Michio,Mizowaki Takashi,Uza Norimitsu,Fukuda Akihisa,Matsumoto Shigemi,Kanai Masashi,Isoda Hiroyoshi,Mizumoto Masaki,Seo Satoru,Hata Koichiro,Taura Kojiro,Kawaguchi Yoshiya,Takaori Kyoichi,Uemoto Shinji,Hatano Etsuro
Abstract
Abstract
Background
Borderline resectable pancreatic cancer (BRPC) is a category of pancreatic cancer that is anatomically widely spread, and curative resection is uncommon with upfront surgery. Intensity-modulated radiation therapy (IMRT) is a form of radiation therapy that delivers precise radiation to a tumor while minimizing the dose to surrounding normal tissues. Here, we conducted a phase 2 study to estimate the curability and efficacy of neoadjuvant chemoradiotherapy using IMRT (NACIMRT) for patients with BRPC with arterial abutment (BRPC-A).
Methods
A total of 49 BRPC-A patients were enrolled in this study and were treated at our hospital according to the study protocol between June 2013 and March 2021. The primary endpoint was microscopically margin-negative resection (R0) rates and we subsequently analyzed safety, histological effect of the treatment as well as survivals among patients with NACIMRT.
Results
Twenty-nine patients (59.2%) received pancreatectomy after NACIMRT. The R0 rate in resection patients was 93.1% and that in the whole cohort was 55.1%. No mortality was encountered. Local therapeutic effects as assessed by Evans classification showed good therapeutic effect (Grade 1, 3.4%; Grade 2a, 31.0%; Grade 2b, 48.3%; Grade 3, 3.4%; Grade 4, 3.4%). Median disease-free survival was 15.5 months. Median overall survival in the whole cohort was 35.1 months. The only independent prognostic pre-NACIMRT factor identified was serum carbohydrate antigen 19–9 (CA19-9) > 400 U/ml before NACIMRT.
Conclusions
NACIMRT showed preferable outcome without significant operative morbidity for BRPC-A patients. NACIMRT contributes to good local tumor control, but a high initial serum CA19-9 implies poor prognosis even after neoadjuvant treatment.
Trial Registration
UMIN-CTR Clinical Trial: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000011776
Registration number: UMIN000010113.
Date of first registration: 01/03/2013,
Publisher
Springer Science and Business Media LLC
Subject
Cancer Research,Genetics,Oncology
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