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Abstract
Introduction. The results of systemic neoadjuvant chemotherapy and/or radiotherapy (RT) for resectable and borderline resectable pancreatic cancer (PCa) are currently controversial.
Aim. Aim of this study is to evaluate the immediate and long-term outcomes of preoperative regional chemotherapy (RCT) combined with conformal radiotherapy (CRT) in patients with pancreatic head cancer (PHC).
Materials and Methods. Between 2011 and 2022, 435 PHC patients received neoadjuvant therapy. The study included 57 patients. The main study group included 28 patients who received neoadjuvant chemoradiotherapy (CRT). The first step was RCT in the form of chemoembolization of the pancreatic head with gemcitabine and lipiodol suspension, followed by intra-arterial chemoinfusion of gemcitabine and oxaliplatin. After 3-5 days CRT was performed using a multifractionation regimen: 2 Gy in single fraction 4 times a day, up to a dose of 50 Gy. Radical pylorus-preserving pancreaticoduodenectomy was performed on average 9 (from 1 to 26) days after CRT. In the control group without CRT, only neoadjuvant RCT with the same regimen without CRT was performed in 29 patients. Operation was performed after three to five days after neoadjuvant therapy.
Results. There were no statistically significant differences in operative time and blood loss between the CRT and control groups (p < 0.05). There were no deaths and no adverse events greater than grade 2 by CTCAE v. 5.0 in either group before surgery. In 24 patients (85.7 %) in the CRT group and 23 (79.3 %) in the control group, adverse events did not require a delay in surgery. Clavien-Dindo complications did not exceed grade III in either group. Disease-free survival was 12.3 (95 % CI 5.3-21.2) months in the main group and 6.7 (95 % CI 5.0-9.1) months in the control group (p < 0.05). Median overall survival and 1-year overall survival were 26.1 (95 % CI 10.2-29.3) months and 63 % vs 10.7 (95 % CI 8.5-13.9) months and 45 %, respectively (p < 0.05).
Conclusion. Preoperative combination of RCT (intra-arterial embolization and intra-arterial infusion) with CRT is associated with no serious complications and allows doubling of survival in patients after pylorus-preserving pancreaticoduodenectomy.
References
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