Potential disadvantages of preoperative chemoradiotherapy are more complicated surgery by radiation toxicity and fewer resections because of early tumor progression. In addition, compliance with preoperative chemoradiotherapy is better compared with postoperative chemotherapy. R0 resection rate is an important prognostic factor, diminishing local and distant recurrence rates, hence improving survival. 9, 10 Preoperative chemoradiotherapy, by inducing downstaging of the tumor, might increase the R0 resection rate. Preoperative (neoadjuvant) chemoradiotherapy in patients with resectable or borderline resectable PDAC has not yet been proven superior, although it is standard of care for many other cancers.
3- 5 Furthermore, approximately half of the resections are microscopically incomplete (R1) 6, 7 one quarter of patients will develop disease recurrence within 6 months. 1, 2 Only approximately half of the patients who undergo tumor resection actually receive adjuvant chemotherapy. Standard treatment is resection followed by adjuvant chemotherapy. 096).Īpproximately 20% of patients with pancreatic ductal adenocarcinoma (PDAC) have resectable or borderline resectable disease. The proportion of patients who suffered serious adverse events was 52% versus 41% ( P =. Survival analysis of patients who underwent tumor resection and started adjuvant chemotherapy showed improved survival with preoperative chemoradiotherapy (35.2 v 19.8 months P =. Preoperative chemoradiotherapy was associated with significantly better disease-free survival and locoregional failure-free interval as well as with significantly lower rates of pathologic lymph nodes, perineural invasion, and venous invasion. The R0 resection rate was 71% (51 of 72) in patients who received preoperative chemoradiotherapy and 40% (37 of 92) in patients assigned to immediate surgery ( P <. The resection rate was 61% and 72% ( P =. Median overall survival by intention to treat was 16.0 months with preoperative chemoradiotherapy and 14.3 months with immediate surgery (hazard ratio, 0.78 95% CI, 0.58 to 1.05 P =. and G.v.T contributed equally to this article.īetween April 2013 and July 2017, 246 eligible patients were randomly assigned 119 were assigned to preoperative chemoradiotherapy and 127 to immediate surgery. 1Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the NetherlandsĢDepartment of Surgery, Erasmus MC Cancer Institute, Rotterdam, the NetherlandsģClinical Research Department, Comprehensive Cancer Organisation the Netherlands (IKNL), Nijmegen, the NetherlandsĤDepartment of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the NetherlandsĥDepartment of Surgery, Leiden University Medical Center, Leiden, the NetherlandsĦDepartment of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the NetherlandsħDepartment of Medical Oncology, Catharina Hospital, Eindhoven, the NetherlandsĨDepartment of Surgery, Division of Hepato-Pancreato-Biliary & Oncology, European Surgery Center Aachen Maastricht, Maastricht UMC+, Maastricht, the NetherlandsĩDepartment of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlandsġ0Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlandsġ1Department of Medical Oncology, Isala Oncology Centre, Zwolle, the Netherlandsġ2Department of Surgery, Catharina Hospital, Eindhoven, the Netherlandsġ3Department of Gastroenterology and Hepatology, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlandsġ4Department of Medical Oncology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlandsġ5Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlandsġ6Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlandsġ7Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlandsġ8Department of Radiation Oncology, Isala Oncology Center, Zwolle, the Netherlandsġ9Department of Surgery, Isala Oncology Center, Zwolle, the NetherlandsĢ0Department of Radiation Oncology, Catharina Hospital, Eindhoven, the NetherlandsĢ1Department of Internal Medicine, Division of Medical Oncology, GROW School for Oncology and Developmental Biology, Maastricht UMC+, Maastricht, the NetherlandsĢ2Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the NetherlandsĢ3Department of Clinical Epidemiologic Biostatics, Amsterdam UMC, University of Amsterdam, Amsterdam, the NetherlandsĬ.H.v.E.
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