title: [The Efficacy of Neoadjuvant Chemoradiation Therapy for Borderline Resectable Pancreatic Cancer].
abstract: BACKGROUND
  Surgical outcomes for locally advanced pancreatic cancer with severe vascular invasion are generally poor. The aim of this study was to evaluate whether neoadjuvant chemoradiation therapy (NACRT) could improve the survival of patients with locally advanced pancreatic cancer without distant metastasis.
  
  
  METHODS
  Between 2010 and 2014, a total of 20 consecutive patients with locally advanced pancreatic cancer without distant metastasis were treated with NACRT. These patients included borderline resectable (BR) and unresectable (UR) pancreatic cancer patients according to the NCCN guidelines. All patients were treated with 2 courses of low-dose gemcitabine plus S-1 combination (GS) chemotherapy and 50.4 Gy of radiation therapy. Restaging was performed 4-6 weeks after completion of NACRT, and curative resection was performed if local control was achieved and distant metastasis was absent.
  
  
  RESULTS
  Of the 20 patients, 7 (35.0%) underwent curative resection after NACRT. R0 resections were achieved in 6 patients (85.6%), and R1 resection was achieved in only 1 patient. Curative operation could not be performed in 13 patients (65.0%), because 3 patients refused surgery, 3 patients were diagnosed with dissemination on probe laparotomy or laparoscopy, and 7 patients had progressive disease with liver metastasis or dissemination on CT or MRI. Patients with a curative operation had a median disease-free survival (DFS) of 16.3 months and a median overall survival (OS) of 25.2 months. All of the patients without curative operation were treated with full-dose GS chemotherapy after NACRT. These patients had a median OS of 11.3 months.
  
  
  CONCLUSIONS
  Our strategy for treating BR or UR pancreatic cancer patients seems to be effective and there might be survival benefits if curative operations can be performed after NACRT.
authors.affiliation: Dept. of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center.
authors.forename: Toru
authors.initials: T
authors.lastname: Sano
authors.forename: Kiminori
authors.initials: K
authors.lastname: Takano
authors.forename: Naokazu
authors.initials: N
authors.lastname: Chiba
authors.forename: Koichi
authors.initials: K
authors.lastname: Tomita
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Ozawa
authors.forename: Kosuke
authors.initials: K
authors.lastname: Hikita
authors.forename: Motohide
authors.initials: M
authors.lastname: Shimazu
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Kawachi
mesh_terms: D000368:Aged; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D016896:Treatment Outcome