Trial of Neoadjuvant Chemoradiation Therapy for Borderline Resectable Pancreatic Cancer

[ABSTRACT] [Purpose]: The purpose of this report was to assess therapeutic outcome of neoadjuvant chemoradiation therapy (NACRT) for borderline resectable pancreatic cancer. [Patients and Methods]: The subjects were seven patients who underwent NACRT for borderline resectable pancreatic cancer from 2009 to 2013 at our institute. The patients received neoadjuvant chemotherapy with S-1 or gemcitabine in addition to standard fractionated radiation therapy. We retrospectively investigated their therapeutic outcomes. [Results]: Resectability after NACRT was 57% (4/7), and these four patients underwent elective pancreatic resection, consisting of pancreaticoduodenectomy (PD) in one patient, distal pancreatectomy (DP) in two and distal pancreatectomy with en bloc celiac axis resection (DPCAR) in one. R0 resection was obtained in all patients who underwent resection. The other three patients did not undergo pancreas resection due to the presence of contraindicating factors such as liver metastases or lung metastases during or just after NACRT. In these patients, the primary lesions decreased in size slightly, but vascular invasion was still observed. Among the four patients who underwent pancreas resection, two are alive without recurrence at 6 and 19 months after starting treatment and one is alive with lymph node metastases at 24 months. The remaining patient died due to carcinomatosa 17 months after the operation. [Conclusion]: NACRT for borderline resectable pancreatic cancer seems to be promising in terms of R0 surgical resection, while novel non-surgical treatment for advanced pancreatic cancer is needed to prevent distant metastasis.