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Pathologic response with neoadjuvant chemotherapy and stereotactic body radiotherapy for borderline resectable and locally-advanced pancreatic cancer

Rajagopalan, MS and Heron, DE and Wegner, RE and Zeh, HJ and Bahary, N and Krasinskas, AM and Lembersky, B and Brand, R and Moser, AJ and Quinn, AE and Burton, SA (2013) Pathologic response with neoadjuvant chemotherapy and stereotactic body radiotherapy for borderline resectable and locally-advanced pancreatic cancer. Radiation Oncology, 8 (1).

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Abstract

Background: Neoadjuvant stereotactic body radiotherapy (SBRT) has potential applicability in the management of borderline resectable and locally-advanced pancreatic adenocarcinoma. In this series, we report the pathologic outcomes in the subset of patients who underwent surgery after neoadjuvant SBRT. Methods: Patients with borderline resectable or locally-advanced pancreatic adenocarcinoma who were treated with SBRT followed by resection were included. Chemotherapy was to the discretion of the medical oncologist and preceded SBRT for most patients. Results: Twelve patients met inclusion criteria. Most (92%) received neoadjuvant chemotherapy, and gemcitabine/capecitabine was most frequently utilized (n = 7). Most were treated with fractionated SBRT to 36 Gy/3 fractions (n = 7) and the remainder with single fraction to 24 Gy (n = 5). No grade 3+ acute toxicities attributable to SBRT were found. Two patients developed post-surgical vascular complications and one died secondary to this. The mean time to surgery after SBRT was 3.3 months. An R0 resection was performed in 92% of patients (n = 11/12). In 25% (n = 3/12) of patients, a complete pathologic response was achieved, and an additional 16.7% (n = 2/12) demonstrated <10% viable tumor cells. Kaplan-Meier estimated median progression free survival is 27.4 months. Overall survival is 92%, 64% and 51% at 1-, 2-, and 3-years. Conclusions: This study reports the pathologic response in patients treated with neoadjuvant chemotherapy and SBRT for borderline resectable and locally-advanced pancreatic cancer. In our experience, 92% achieved an R0 resection and 41.7% of patients demonstrated either complete or extensive pathologic response to treatment. The results of a phase II study of this novel approach will be forthcoming. © 2013 Rajagopalan et al.; licensee BioMed Central Ltd.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Rajagopalan, MS
Heron, DEdeh5@pitt.eduDEH5
Wegner, RE
Zeh, HJhjz1@pitt.eduHJZ1
Bahary, Nbahary@pitt.eduBAHARY
Krasinskas, AM
Lembersky, B
Brand, Rreb53@pitt.eduREB53
Moser, AJ
Quinn, AE
Burton, SA
Centers: Other Centers, Institutes, or Units > Pittsburgh Cancer Institute
Date: 31 October 2013
Date Type: Publication
Journal or Publication Title: Radiation Oncology
Volume: 8
Number: 1
DOI or Unique Handle: 10.1186/1748-717x-8-254
Schools and Programs: School of Medicine > Medicine
School of Medicine > Pathology
School of Medicine > Radiation Oncology
School of Medicine > Surgery
Refereed: Yes
Date Deposited: 02 Dec 2016 16:10
Last Modified: 02 Feb 2019 15:58
URI: http://d-scholarship.pitt.edu/id/eprint/29662

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