title: Neoadjuvant chemoradiation with IMRT in resectable and borderline resectable pancreatic cancer.
abstract: OBJECTIVE
  Neoadjuvant chemoradiation is an alternative to the surgery-first approach for resectable pancreatic cancer (PDA) and represents the standard of care for borderline resectable (BLR).
  
  
  METHODS
  All patients with resectable and BLR PDA treated with neoadjuvant chemoradiation using IMRT between 1/2009 and 11/2011 were reviewed. Patients were treated to a customized CTV which included the primary mass and regional vessels.
  
  
  RESULTS
  Neoadjuvant chemoradiation was completed in 69 patients (39 BLR and 30 resectable). Induction chemotherapy was used in 32 (82%) of the 39 patients with BLR disease prior to chemoXRT. All resectable patients were treated with chemoXRT alone. Following neoadjuvant treatment, 48 (70%) of the 69 patients underwent successful pancreatic resection with 47 (98%) being margin negative (RO). In 30 of the BLR patients who had arterial abutment or SMV occlusion, 19 (63%) were surgically resected and all had RO resections. The cumulative incidence of local failure at 1 and 2 years was 2% (95% CI 0-6%) and 9% (95% CI 0.6-17%) respectively. The median overall survival for all patients, patients undergoing resection, and patients without resection were 20, 26 and 11 months respectively. Sixteen (23%) of the 69 patients are alive without disease with a median follow-up of 47 months (36-60).
  
  
  CONCLUSIONS
  Neoadjuvant chemoXRT can facilitate a margin negative resection in patients with localized PCa.
authors.affiliation: The University of Cincinnati, Department of Radiation Oncology, Cincinnati, United States.
authors.forename: Jordan
authors.initials: J
authors.lastname: Kharofa
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, United States.
authors.forename: Susan
authors.initials: S
authors.lastname: Tsai
authors.affiliation: Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, United States.
authors.forename: Tracy
authors.initials: T
authors.lastname: Kelly
authors.affiliation: Advanced Radiation Oncology, Greenwood, United States.
authors.forename: Clint
authors.initials: C
authors.lastname: Wood
authors.affiliation: Department of Medical Oncology, Medical College of Wisconsin, Milwaukee, United States.
authors.forename: Ben
authors.initials: B
authors.lastname: George
authors.affiliation: Department of Medical Oncology, Medical College of Wisconsin, Milwaukee, United States.
authors.forename: Paul
authors.initials: P
authors.lastname: Ritch
authors.affiliation: Department of Medical Oncology, Medical College of Wisconsin, Milwaukee, United States.
authors.forename: Lauren
authors.initials: L
authors.lastname: Wiebe
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, United States.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Christians
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, United States.
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
authors.affiliation: Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, United States. Electronic address: berickson@mcw.edu.
authors.forename: Beth
authors.initials: B
authors.lastname: Erickson
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000628:therapy*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Borderline resectable; IMRT; Neoadjuvant chemoradiation; Pancreatic cancer