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Abstract
Introduction. The role of regional chemotherapy (RCT) combined with radiation therapy (RT) in pancreatic cancer patients remains incompletely defined.
Aim. To compare immediate and long-term outcomes of combined RCT and RT versus pancreaticoduodenectomy (PD) in patients with resectable pancreatic cancer who are at high surgical risk for complications and mortality.
Materials and Methods. The study group comprised 33 patients with pancreatic head adenocarcinoma (stage T2-3N0-1M0 IB-IIB) and ASA class III physical status. Treatment involved initial chemoembolization of the pancreatic head tumor using gemcitabine and Lipiodol, followed by celiac artery infusion of gemcitabine and oxaliplatin (GEMOX regimen). The second phase consisted of radiation therapy delivered in a daily fractionated dose (4 Gy/day) to a total focal dose of 50 Gy. The control group included 36 patients with matching disease stages and ASA class III status who underwent PD at a multidisciplinary clinic.
Results. No hospital mortality occurred following chemoradiotherapy. Postoperative mortality in the control group was 13.9 % (n = 5). Grade III–IV complications (Clavien — Dindo classification) were observed exclusively in the surgical group (n = 15, 41.7 %; p < 0.05). Median time to progression was 7.8 months (CI 6.9–8.4) after chemoradiotherapy versus 10.7 months (95 % CI: 7.9–15.5) after surgery (p < 0.05). Median overall survival and 1-year survival rates were 12.4 months (95 % CI: 10.5–17.8) and 50 % versus 17.4 months (95 % CI: 11.6–25.5) and 64 %, respectively (p < 0.05). However, overall survival based on deceased patients (n = 26 vs n = 28) showed no significant difference: 14.1 months (95 % CI: 11.5–16.6) versus 14.5 months (95 % CI: 10.5–18.5; p < 0.05).
Conclusion. Despite elevated mortality and complication rates, pancreaticoduodenectomy demonstrates superior survival outcomes even in medically compromised patients. Identifying contraindications for PD remains crucial; for such high-risk patients, combined regional chemotherapy and radiation therapy with daily fractionation represents a safe and moderately effective alternative.
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