BMC Cancer (Jan 2022)

Impact of neoadjuvant intensity-modulated radiation therapy on borderline resectable pancreatic cancer with arterial abutment; a prospective, open-label, phase II study in a single institution

  • Toshihiko Masui,
  • Kazuyuki Nagai,
  • Takayuki Anazawa,
  • Asahi Sato,
  • Yuichiro Uchida,
  • Kenzo Nakano,
  • Akitada Yogo,
  • Akihiro Kaneda,
  • Naoto Nakamura,
  • Michio Yoshimura,
  • Takashi Mizowaki,
  • Norimitsu Uza,
  • Akihisa Fukuda,
  • Shigemi Matsumoto,
  • Masashi Kanai,
  • Hiroyoshi Isoda,
  • Masaki Mizumoto,
  • Satoru Seo,
  • Koichiro Hata,
  • Kojiro Taura,
  • Yoshiya Kawaguchi,
  • Kyoichi Takaori,
  • Shinji Uemoto,
  • Etsuro Hatano

DOI
https://doi.org/10.1186/s12885-022-09244-6
Journal volume & issue
Vol. 22, no. 1
pp. 1 – 11

Abstract

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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,

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