title: A phase II trial of neoadjuvant chemoradiotherapy with intensity-modulated radiotherapy combined with gemcitabine and S-1 for borderline-resectable pancreatic cancer with arterial involvement.
abstract: OBJECTIVE
  Chemoradiotherapy using intensity-modulated radiotherapy (IMRT) is expected to provide a powerful alternative to conventional chemotherapy with a low incidence of adverse events. This study evaluated the efficacy of intensity modulated radiotherapy in combination with gemcitabine and S-1 as neoadjuvant chemoradiotherapy (NACRT) for borderline-resectable pancreatic cancer with arterial involvement (BR-A).
  
  
  METHODS
  A total of 27 patients with BR-A were enrolled in this study between February 2012 and September 2015. IMRT was administered at 50.4 Gy in 28 fractions with concurrent gemcitabine at a dose of 600 mg/m2and S-1 at a dose of 60 mg.
  
  
  RESULTS
  Only one patient (3.5%) experienced gastrointestinal adverse events at grade 3 or higher. Nineteen patients (70.3%) underwent resection, and R0 resection was achieved in 18 patients (94.7%). Thirteen patients (68.4%) developed distant metastasis at the initial site of recurrence after resection. Local recurrence developed in only one of these patients (7.7%). The median overall survival and 1-year survival rates were 22.4 months and 81.3%, respectively.
  
  
  CONCLUSIONS
  Concurrent IMRT with gemcitabine and S-1 for patients is feasible as NACRT for BR-A with low gastrointestinal toxicity. IMRT can be employed as a standard radiotherapy to provide more effective NACRT with powerful chemotherapy drugs.
authors.affiliation: Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan. naga@tokyo-med.ac.jp.
authors.forename: Yuichi
authors.identifier: http://orcid.org/0000-0003-1169-8160
authors.initials: Y
authors.lastname: Nagakawa
authors.affiliation: Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hosokawa
authors.affiliation: Department of Radiation Oncology, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Hidetsugu
authors.initials: H
authors.lastname: Nakayama
authors.affiliation: Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
authors.forename: Yatsuka
authors.initials: Y
authors.lastname: Sahara
authors.affiliation: Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
authors.forename: Chie
authors.initials: C
authors.lastname: Takishita
authors.affiliation: Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
authors.forename: Tetsushi
authors.initials: T
authors.lastname: Nakajima
authors.affiliation: Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Hijikata
authors.affiliation: Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kasuya
authors.affiliation: Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Katsumata
authors.affiliation: Department of Radiology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Tokuuye
authors.affiliation: Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Tsuchida
mesh_terms: D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001158:Arteries / Q000473:pathology*; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods*; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000379:methods*; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D010094:Oxonic Acid / Q000008:administration & dosage; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D011446:Prospective Studies; D050397:Radiotherapy, Intensity-Modulated; D015996:Survival Rate; D005641:Tegafur / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D004338:Drug Combinations; D003841:Deoxycytidine; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D000093542:Gemcitabine
keywords: Borderline-resectable pancreatic cancer; Chemoradiation; Intensity modulated radiotherapy; Neoadjuvant therapy; Pancreatic cancer