Neoadjuvant Gemcitabine Chemotherapy followed by Concurrent IMRT Simultaneous Boost Achieves High R0 Resection in Borderline Resectable Pancreatic Cancer Patients

• Published in: PloS one 2016-12, Vol.11 (12), p.e0166606
• Main Authors: Huang, Xiaolun, Knoble, Jeanna L, Zeng, Ming, Aguila, Fernando N, Patel, Tara, Chambers, Lowell W, Hu, Honglin, Liu, Hao
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cancer; Cancer therapies; Care and treatment; Chemoradiotherapy - adverse effects; Chemoradiotherapy - methods; Chemotherapy; Colitis - etiology; Deoxycytidine - administration & dosage; Deoxycytidine - analogs & derivatives; Dosage and administration; Feasibility Studies; Febrile Neutropenia - etiology; Female; Fluorouracil - administration & dosage; Gemcitabine; Health aspects; Hematology; Hospitals; Humans; Intensity-modulated radiotherapy; Male; Medicine and Health Sciences; Metastases; Metastasis; Middle Aged; Neoadjuvant therapy; Neoadjuvant Therapy - adverse effects; Oncology; Organs; Pancreas - drug effects; Pancreas - radiation effects; Pancreas - surgery; Pancreatectomy - adverse effects; Pancreatectomy - methods; Pancreatic cancer; Pancreatic Neoplasms - surgery; Pancreatic Neoplasms - therapy; Patients; Positron emission; Radiation; Radiation therapy; Radiotherapy, Intensity-Modulated - methods; Simulation; Stem cells; Surgery; Systematic review; Thrombocytopenia - etiology; Tomography; Toxicity; Treatment Outcome; Veins & arteries
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0166606

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. 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. 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. 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.