title: Neoadjuvant Gemcitabine Chemotherapy followed by Concurrent IMRT Simultaneous Boost Achieves High R0 Resection in Borderline Resectable Pancreatic Cancer Patients.
abstract: BACKGROUND
  To study the feasibility of down stage the borderline resectable pancreatic cancer (BRPC) to resectable disease, we reported our institutional results using an intensity-modulated radiation therapy (IMRT) simultaneous integrated boost (SIB) dose escalation approach to improve R0 resectability.
  
  
  METHODS
  We reviewed our past 7 years of experience of using neoadjuvant induction chemotherapy with Gemcitabine followed by concurrent chemoradiaiton for BRPC. During the concurrent, chemo was 5-FU and radiation were IMRT with SIB technique to target the key areas with dose escalation to 5600 in 28 fractions. The key areas were defined by PET positive area. This was followed by restaging imaging to rule out distant metastases before resection.
  
  
  RESULTS
  25 finished dose escalation protocol. 2 of the 25 cases developed distant metastases, 23 (92%) patients without distant metastases underwent pancreatectomy. Among the those received pancreatectomy, 22 (95%) achieved negative margin (R0). The gastrointestinal toxicity > grade 2 was 8% and there was no grade 4 toxicity.
  
  
  CONCLUSIONS
  Neoadjuvant Gemcitabine-based induction chemotherapy followed by 5-FU-based IMRT-SIB is a feasible option in improving the likelihood of R0 resection rate in BRPC without compromising the organs at risk for toxicity.
authors.affiliation: Department of Hepatobiliary-Pancreatic Surgery and Cell Transplant Center, the Affiliated Hospital of University of Electronic Science and Technology, Chengdu, Sichuan, China.
authors.forename: Xiaolun
authors.initials: X
authors.lastname: Huang
authors.affiliation: Department of Hematology and Oncology, Zangmeister Cancer Center, Mount Carmel Health System, Columbus, Ohio, United States of America.
authors.forename: Jeanna L
authors.initials: JL
authors.lastname: Knoble
authors.affiliation: Department of Radiation Oncology, Mount Carmel Health System, Columbus, Ohio, United States of America.
authors.forename: Ming
authors.identifier: http://orcid.org/0000-0002-4294-2077
authors.initials: M
authors.lastname: Zeng
authors.affiliation: Central Ohio Surgical Associates, Inc., Columbus, Ohio, United States of America.
authors.forename: Fernando N
authors.initials: FN
authors.lastname: Aguila
authors.affiliation: Department of Hematology and Oncology, Zangmeister Cancer Center, Mount Carmel Health System, Columbus, Ohio, United States of America.
authors.forename: Tara
authors.initials: T
authors.lastname: Patel
authors.affiliation: Central Ohio Surgical Associates, Inc., Columbus, Ohio, United States of America.
authors.forename: Lowell W
authors.initials: LW
authors.lastname: Chambers
authors.affiliation: Cancer Center, the Affiliated Hospital of University of Electronic Science and Technology, Chengdu, Sichuan, China.
authors.forename: Honglin
authors.initials: H
authors.lastname: Hu
authors.affiliation: Cancer Center, the Affiliated Hospital of University of Electronic Science and Technology, Chengdu, Sichuan, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Liu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods; D003092:Colitis / Q000209:etiology; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005240:Feasibility Studies; D064147:Febrile Neutropenia / Q000209:etiology; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D010179:Pancreas / Q000187:drug effects / Q000528:radiation effects / Q000601:surgery; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods; D010190:Pancreatic Neoplasms / Q000601:surgery* / Q000628:therapy*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D013921:Thrombocytopenia / Q000209:etiology; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D005472:Fluorouracil; D000093542:Gemcitabine