Preoperative Capecitabine and Concurrent Radiation for Borderline Resectable Pancreatic Cancer

• Published in: Annals of surgical oncology Vol. 18; no. 3; pp. 619 - 627
• Main Authors: Stokes, Jayme B., Nolan, Norris J., Stelow, Edward B., Walters, Dustin M., Weiss, Geoffrey R., de Lange, Eduard E., Rich, Tyvin A., Adams, Reid B., Bauer, Todd W.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-03-2011; Springer Nature B.V
• Subjects: Adenocarcinoma - therapy; Aged; Aged, 80 and over; Antimetabolites, Antineoplastic - therapeutic use; Capecitabine; Carcinoma, Pancreatic Ductal - therapy; Chemotherapy, Adjuvant; Combined Modality Therapy; Deoxycytidine - analogs & derivatives; Deoxycytidine - therapeutic use; Female; Fluorouracil - analogs & derivatives; Fluorouracil - therapeutic use; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Neoadjuvant Therapy; Neoplasm Staging; Oncology; Pancreatectomy; Pancreatic cancer; Pancreatic Neoplasms - therapy; Pancreatic Tumors; Preoperative Care; Prospective Studies; Radiotherapy, Adjuvant; Retrospective Studies; Surgery; Surgical Oncology; Survival Rate; Treatment Outcome; Intensity Modulate Radiation Treatment; Superior Mesenteric Artery; Gross Tumor Volume; Pancreatic Resection; Pancreatic Ductal Adenocarcinoma
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-010-1456-7

Background
Patients with borderline resectable pancreatic ductal adenocarcinoma (PDA) represent a high-risk group of patients due to tumor or patient-related characteristics. The optimal management of these patients has not been fully defined.
Materials and Methods
All patients undergoing evaluation for PDA between 2005 and 2008 were identified. Clinical, radiographic, and pathological data were retrospectively reviewed. Patients were staged as borderline resectable using the M.D. Anderson Cancer Center (MDACC) classification.
Results
A total of 170 patients with PDA were identified, 40 with borderline resectable disease. Of these, 34 borderline resectable patients (85%) completed neoadjuvant therapy and were restaged; pancreatic resection was completed in 16 patients (46%). Also, 8 patients completed 50 Gy of radiation in 28 fractions in 6 weeks, whereas 8 patients received 50 Gy in 20 fractions in 4 weeks plus chronomodulated capecitabine. An R0 resection was achieved in 12 of the 16 patients (75%). Also, 5 patients (63%) treated in 20 fractions had >90% pathologic response versus 1 (13%) treated in 28 fractions (
P
 < .05). Borderline resectable patients completing surgery had similar survival to patients with resectable disease who underwent surgery. Patients receiving accelerated fractionation radiation had improved survival compared with patients treated with standard fractionation protocol.
Conclusions
A neoadjuvant approach to borderline resectable PDA identifies patients who are most likely to benefit from pancreatic resection. Preoperative capecitabine-based chemoradiation is an effective, well-tolerated treatment for these patients. Neoadjuvant therapy for borderline resectable PDA warrants further investigation using treatment schedules that can safely intensify irradiation dose.