Please read Dr. Neibart’s article in the Journal of Gastrointestinal Oncology titled, “Outcomes of patients with borderline resectable and resectable pancreatic adenocarcinoma treated with neoadjuvant three-week course chemoradiotherapy using capecitabine-based versus gemcitabine-based concurrent chemotherapy.“
Pancreatic ductal adenocarcinoma (PDAC) represents just 3% of all cancer diagnoses annually but is the fourth leading cause of cancer-related death in the United States. Approximately 15–20% of all PDAC diagnoses are borderline resectable or resectable at diagnosis, typically necessitating neoadjuvant treatment to enable downstaging and margin-negative resection. Margin-negative resection is strongly associated with survival, but the optimal preoperative regimen to facilitate an optimal surgical outcome is highly debated.
A 3-week course of chemoradiation (3WCRT) with 3,600 cGy in 15 fractions is a regimen utilized for patients with borderline resectable and resectable pancreatic cancer [(B)RPC]. First evaluated in patients with locally advanced PDAC, 3WCRT with concurrent gemcitabine (GEM) was extended to the (B)RPC setting after demonstrating promising surgical and survival outcomes, even for patients who were deemed initially unresectable. The preoperative radiochemotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer (PREOPANC)-1 trial subsequently demonstrated advantages of a neoadjuvant approach with 3WCRT over directly proceeding with surgery. Although the study failed to show an overall survival (OS) benefit of 3WCRT with concurrent GEM, the 3WCRT group had superior R0 resection rate, disease-free survival, and locoregional control. To read the full article.
Outcomes of patients with borderline resectable and resectable pancreatic adenocarcinoma treated with neoadjuvant three-week course chemoradiotherapy using capecitabine-based versus gemcitabine-based concurrent chemotherapy. Neibart, S., Mamidanna, S., Chundury, A., Sayan, M., Alexander, H., August, D., Berim, L., Boland, P., Grandhi, M., Gulhati, P., Hochster, H., Langan, R., Spencer, K., Kennedy, T., Deek, M., Jabbour, S. J Gastrointest Oncol. 2021. DOI: 21037/jgo-21-503 PMID: 35070387 PMCID: PMC8748032 DOI: 10.21037/jgo-21-503