title: Favorable perioperative outcomes after resection of borderline resectable pancreatic cancer treated with neoadjuvant stereotactic radiation and chemotherapy compared with upfront pancreatectomy for resectable cancer.
abstract: BACKGROUND
  Neoadjuvant multi-agent chemotherapy and stereotactic body radiation therapy (SBRT) are utilized to increase margin negative (R0) resection rates in borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC) patients. Concerns persist that these neoadjuvant therapies may worsen perioperative morbidities and mortality.
  
  
  METHODS
  Upfront resection patients (n=241) underwent resection without neoadjuvant treatment for resectable disease. They were compared to BRPC or LAPC patients (n=61) who underwent resection after chemotherapy and 5 fraction SBRT. Group comparisons were performed by Mann-Whitney U or Fisher's exact test. Overall Survival (OS) was estimated by Kaplan-Meier and compared by log-rank methods.
  
  
  RESULTS
  In the neoadjuvant therapy group, there was significantly higher T classification, N classification, and vascular resection/repair rate. Surgical positive margin rate was lower after neoadjuvant therapy (3.3% vs. 16.2%, P=0.006). Post-operative morbidities (39.3% vs. 31.1%, P=0.226) and 90-day mortality (2% vs. 4%, P=0.693) were similar between the groups. Median OS was 33.5 months in the neoadjuvant therapy group compared to 23.1 months in upfront resection patients who received adjuvant treatment (P=0.057).
  
  
  CONCLUSIONS
  Patients with BRPC or LAPC and sufficient response to neoadjuvant multi-agent chemotherapy and SBRT have similar or improved peri-operative and long-term survival outcomes compared to upfront resection patients.
authors: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA ;
authors: Eric A
authors: EA
authors: Mellon
authors: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA ;
authors: Tobin J
authors: TJ
authors: Strom
authors: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA ;
authors: Sarah E
authors: SE
authors: Hoffe
authors: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA ;
authors: Jessica M
authors: JM
authors: Frakes
authors: Gastrointestinal Tumor Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA ;
authors: Gregory M
authors: GM
authors: Springett
authors: Gastrointestinal Tumor Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA ;
authors: Pamela J
authors: PJ
authors: Hodul
authors: Gastrointestinal Tumor Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA ;
authors: Mokenge P
authors: MP
authors: Malafa
authors: Department of Radiation Oncology, University of Maryland, Baltimore, MD, USA ;
authors: Michael D
authors: MD
authors: Chuong
authors: Florida Hospital Cancer Institute, Orlando, FL, USA.
authors: Ravi
authors: R
authors: Shridhar
keywords: Radiotherapy; neoadjuvant therapy; pancreatic neoplasms