Impact of Neoadjuvant Intensity-modulated Radiation Therapy on Borderline Resectable Pancreatic Cancer with Arterial Abutment; a Prospective, Open-label, Phase II Study in a Single Institution

Overview

Journal BMC Cancer

Publisher Biomed Central

Specialty Oncology

Date 2022 Jan 30

PMID 35093003

Authors

Toshihiko Masui

Kazuyuki Nagai

Takayuki Anazawa

Asahi Sato

Yuichiro Uchida

Kenzo Nakano

Akitada Yogo

Akihiro Kaneda

Naoto Nakamura

Michio Yoshimura

Takashi Mizowaki

Norimitsu Uza

Akihisa Fukuda

Shigemi Matsumoto

Masashi Kanai

Hiroyoshi Isoda

Masaki Mizumoto

Satoru Seo

Koichiro Hata

Kojiro Taura

Yoshiya Kawaguchi

Kyoichi Takaori

Shinji Uemoto

Etsuro Hatano

Affiliations

Soon will be listed here.

Abstract

Background: Borderline resectable pancreatic cancer (BRPC) is a category of pancreatic cancer that is anatomically widely spread, and curative resection is uncommon with upfront surgery. Intensity-modulated radiation therapy (IMRT) is a form of radiation therapy that delivers precise radiation to a tumor while minimizing the dose to surrounding normal tissues. Here, we conducted a phase 2 study to estimate the curability and efficacy of neoadjuvant chemoradiotherapy using IMRT (NACIMRT) for patients with BRPC with arterial abutment (BRPC-A).

Methods: A total of 49 BRPC-A patients were enrolled in this study and were treated at our hospital according to the study protocol between June 2013 and March 2021. The primary endpoint was microscopically margin-negative resection (R0) rates and we subsequently analyzed safety, histological effect of the treatment as well as survivals among patients with NACIMRT.

Results: Twenty-nine patients (59.2%) received pancreatectomy after NACIMRT. The R0 rate in resection patients was 93.1% and that in the whole cohort was 55.1%. No mortality was encountered. Local therapeutic effects as assessed by Evans classification showed good therapeutic effect (Grade 1, 3.4%; Grade 2a, 31.0%; Grade 2b, 48.3%; Grade 3, 3.4%; Grade 4, 3.4%). Median disease-free survival was 15.5 months. Median overall survival in the whole cohort was 35.1 months. The only independent prognostic pre-NACIMRT factor identified was serum carbohydrate antigen 19-9 (CA19-9) > 400 U/ml before NACIMRT.

Conclusions: NACIMRT showed preferable outcome without significant operative morbidity for BRPC-A patients. NACIMRT contributes to good local tumor control, but a high initial serum CA19-9 implies poor prognosis even after neoadjuvant treatment.

Trial Registration: UMIN-CTR Clinical Trial: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000011776 Registration number: UMIN000010113. Date of first registration: 01/03/2013.

Citing Articles

Neoadjuvant Chemoradiotherapy Using Moderately Hypofractionated Intensity-Modulated Radiotherapy Versus Upfront Surgery for Resectable Pancreatic Cancer: A Retrospective Cohort Study.

Yamane K, Anazawa T, Nagai K, Kasai Y, Masui T, Izuwa A Ann Surg Oncol. 2025; .

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Delta-Radiomics Approach Using Contrast-Enhanced and Noncontrast-Enhanced Computed Tomography Images for Predicting Distant Metastasis in Patients With Borderline Resectable Pancreatic Carcinoma.

Adachi T, Nakamura M, Iwai T, Yoshimura M, Mizowaki T Adv Radiat Oncol. 2024; 10(1):101669.

PMID: 39687476 PMC: 11647472. DOI: 10.1016/j.adro.2024.101669.

Safety and efficacy of neoadjuvant chemoradiotherapy with moderately hypofractionated intensity-modulated radiotherapy for resectable pancreatic cancer: A prospective, open-label, phase II study.

Masui T, Nagai K, Anazawa T, Kasai Y, Yogo A, Yoshimura M Cancer Med. 2023; 12(18):18611-18621.

PMID: 37649318 PMC: 10557863. DOI: 10.1002/cam4.6470.

Assessing target localization accuracy across different soft-tissue matching protocols using end-exhalation breath-hold cone-beam computed tomography in patients with pancreatic cancer.

Sasaki M, Nakamura M, Ashida R, Nakata M, Yoshimura M, Mizowaki T J Radiat Res. 2023; 64(4):711-719.

PMID: 37336503 PMC: 10354851. DOI: 10.1093/jrr/rrad048.

Research trends and hotspots of neoadjuvant therapy in pancreatic cancer: a bibliometric analysis based on the Web of Science Core Collection.

Wu H, Liu T, Zhong T, Zheng S, Zhai Q, Du C Clin Exp Med. 2023; 23(6):2473-2485.

PMID: 36773211 DOI: 10.1007/s10238-023-01013-4.

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