Significance of Preoperative Chemotherapy and Chemoradiotherapy in Patients With Locally Advanced and Borderline Resectable Pancreatic Cancer.

BACKGROUND/AIM: Multi-agent chemotherapy regimens have improved the survival of patients with pancreatic adenocarcinoma (PDAC). However, only a few studies have compared multi-regimen treatments with single-regimen followed by curative-intent resection. This study aimed to explore optimal treatment strategies and clarify the role of radiotherapy in borderline resectable PDAC (BRPC) and locally advanced PDAC (LAPC) treatment.

PATIENTS AND

METHODS

Consecutive patients who underwent pancreatectomy for PDAC at our institution between January 2013 and December 2022, diagnosed with BRPC and LAPC, and subjected to radical resection following preoperative chemotherapy or chemoradiotherapy were included in this study. We divided the cohort into preoperative multiple regimen (MR) and single regimen (SR) groups to compare survival.

RESULTS

Of the 527 patients with PDAC, 68 who responded favorably to neoadjuvant therapy and subsequently underwent curative-intent or conversion resection were included in the analysis. In terms of overall survival, the 5-year survival rate was significantly higher in the MR group (80.8%) than in the SR group (20.3%). Multivariate analysis identified R0 resection, preoperative carbohydrate antigen 19-9 levels <80 U/ml, and preoperative treatment with multiple regimens as factors associated with better prognosis.

CONCLUSION

Treatment with multiple regimens may improve the prognosis of patients with LAPC or BRPC. The addition of chemoradiotherapy as a treatment modality may have a positive impact on prognosis.