Neoadjuvant therapy with intensity‐modulated radiotherapy combined with S‐1 for borderline‐resectable pancreatic cancer

Abstract

AbstractAimWe evaluated the efficacy of neoadjuvant chemotherapy with intensity‐modulated radiotherapy (NAC‐IMRT) in patients with borderline‐resectable pancreatic cancer (BRPC).MethodsBRPC patients were treated with IMRT (45 Gy/15fr) combined with two courses of S‐1 (40 mg/m2 bid) before surgery. Outcomes after NAC‐IMRT, surgery, and survival were then evaluated. This single‐center retrospective study assessed 26 consecutive patients.ResultsTwenty‐six patients (BR‐PV: 7, BR‐A: 19) with a median age of 73 years were enrolled from 2016 to 2021. Ten (38%) patients were 75‐years‐old and above. Twenty‐three patients completed NAC‐IMRT treatment. The median reductions in tumor size and cancer antigen 19‐9 level were 13.6% and 69%, respectively. All 26 patients underwent resection within a median time of 71 days after NAC‐IMRT initiation. R0 resection was achieved in 24 patients (92%). The median overall survival (OS) was 28.0 months, and the 1‐ and 3‐year OS rates were 100% and 34%, respectively. The median progression‐free survival (PFS) was 12.5 months, and the 1‐ and 3‐year PFS rates were 50% and 32%, respectively. No significant differences were observed in OS between the patients under and over the age of 75 (29 vs. 20 months, p = 0.86). The 12 patients who completed NAC‐IMRT, resection, and subsequent adjuvant chemotherapy (AC) exhibited a 3‐year survival rate of 73%, which was significantly better than that of the patients who did not receive or complete AC (median OS, not reached vs. 19 months, p < 0.001).ConclusionNAC‐IMRT showed outstanding clinical efficacy with acceptable tolerability in patients with BRPC, including geriatric patients.