Neoadjuvant chemotherapy with chemoradiotherapy for patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma - retrospective review from a tertiary care hospital

Aim: Patients diagnosed with borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC) have historically worse survival rates compared to those with resectable pancreatic cancer. The study aimed to assess the feasibility and efficacy of neoadjuvant chemotherapy and chemoradiotherapy in BRPC/LAPC. Additionally, we evaluated the R0 resection rates for patients who progressed to surgery.

Methods: This retrospective study included patients diagnosed with BRPC/LAPC between January 2019 and December 2023 at The Canberra Hospital (TCH), a tertiary care setting. A total of 115 patients were screened, of whom 37 were eligible for inclusion. Demographic data, CA19-9 levels, treatment regimens, surgical outcomes, resection rates, disease-free survival (DFS), and overall survival were analysed.

Results: A total of 20 (54%) patients (15 FOLFIRINOX and 5 gemcitabine/nab-paclitaxel) completed their planned chemotherapy, and 17 (46%) of these patients had chemoradiotherapy, majority receiving 45-50 Gy of conventional radiation with capecitabine. Tumor marker Ca19-9 normalized after chemotherapy in seven patients (19%). In total, 23 patients (62.2%) progressed to surgery. The median DFS for all patients was 12.7 months (95% CI 5.5-15.9), and the median OS was 21 months (95% CI 13.7-44.9).

Conclusion: This study suggests that neoadjuvant treatment is feasible for BRPC/LAPC, allowing patients to undergo surgery and achieve R0 resection. However, further randomized controlled trials with larger cohorts are needed to validate these findings and refine treatment protocols.