title: Histopathologic tumor response after induction chemotherapy and stereotactic body radiation therapy for borderline resectable pancreatic cancer.
abstract: BACKGROUND
  While clinical outcomes following induction chemotherapy and stereotactic body radiation therapy (SBRT) have been reported for borderline resectable pancreatic cancer (BRPC) patients, pathologic response has not previously been described.
  
  
  METHODS
  This single-institution retrospective review evaluated BRPC patients who completed induction gemcitabine-based chemotherapy followed by SBRT and surgical resection. Each surgical specimen was assigned two tumor regression grades (TRG), one using the College of American Pathologists (CAP) criteria and one using the MD Anderson Cancer Center (MDACC) criteria. Overall survival (OS) and progression free survival (PFS) were correlated to TRG score.
  
  
  RESULTS
  We evaluated 36 patients with a median follow-up of 13.8 months (range, 6.1-24.8 months). The most common induction chemotherapy regimen (82%) was GTX (gemcitabine, docetaxel, capecitabine). A median SBRT dose of 35 Gy (range, 30-40 Gy) in 5 fractions was delivered to the region of vascular involvement. The margin-negative resection rate was 97.2%. Improved response according to MDACC grade trended towards superior PFS (P=061), but not OS. Any neoadjuvant treatment effect according to MDACC scoring (IIa-IV vs. I) was associated with improved OS and PFS (both P=0.019). We found no relationship between CAP score and OS or PFS.
  
  
  CONCLUSIONS
  These data suggest that the increased pathologic response after induction chemotherapy and SBRT is correlated with improved survival for BRPC patients.
authors.affiliation: 1 University of Maryland Medical Center, Baltimore, MD 21201, USA ; 2 H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA ; 3 University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA ; 4 Florida Hospital Cancer Institute, Florida Hospital Orlando, Orlando, FL 32804, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Chuong
authors.affiliation: 1 University of Maryland Medical Center, Baltimore, MD 21201, USA ; 2 H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA ; 3 University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA ; 4 Florida Hospital Cancer Institute, Florida Hospital Orlando, Orlando, FL 32804, USA.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Frakes
authors.affiliation: 1 University of Maryland Medical Center, Baltimore, MD 21201, USA ; 2 H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA ; 3 University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA ; 4 Florida Hospital Cancer Institute, Florida Hospital Orlando, Orlando, FL 32804, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Figura
authors.affiliation: 1 University of Maryland Medical Center, Baltimore, MD 21201, USA ; 2 H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA ; 3 University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA ; 4 Florida Hospital Cancer Institute, Florida Hospital Orlando, Orlando, FL 32804, USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Hoffe
authors.affiliation: 1 University of Maryland Medical Center, Baltimore, MD 21201, USA ; 2 H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA ; 3 University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA ; 4 Florida Hospital Cancer Institute, Florida Hospital Orlando, Orlando, FL 32804, USA.
authors.forename: Ravi
authors.initials: R
authors.lastname: Shridhar
authors.affiliation: 1 University of Maryland Medical Center, Baltimore, MD 21201, USA ; 2 H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA ; 3 University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA ; 4 Florida Hospital Cancer Institute, Florida Hospital Orlando, Orlando, FL 32804, USA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Mellon
authors.affiliation: 1 University of Maryland Medical Center, Baltimore, MD 21201, USA ; 2 H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA ; 3 University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA ; 4 Florida Hospital Cancer Institute, Florida Hospital Orlando, Orlando, FL 32804, USA.
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Hodul
authors.affiliation: 1 University of Maryland Medical Center, Baltimore, MD 21201, USA ; 2 H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA ; 3 University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA ; 4 Florida Hospital Cancer Institute, Florida Hospital Orlando, Orlando, FL 32804, USA.
authors.forename: Mokenge P
authors.initials: MP
authors.lastname: Malafa
authors.affiliation: 1 University of Maryland Medical Center, Baltimore, MD 21201, USA ; 2 H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA ; 3 University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA ; 4 Florida Hospital Cancer Institute, Florida Hospital Orlando, Orlando, FL 32804, USA.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Springett
authors.affiliation: 1 University of Maryland Medical Center, Baltimore, MD 21201, USA ; 2 H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA ; 3 University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA ; 4 Florida Hospital Cancer Institute, Florida Hospital Orlando, Orlando, FL 32804, USA.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Centeno
keywords: Radiation therapy (RT); chemotherapy; pancreatic cancer