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Abstract
OBJECTIVE:
This study was performed to determine whether neoadjuvant treatment increases survival in patients with BRPC.

SUMMARY BACKGROUND DATA:
Despite many promising retrospective data on the effect of neoadjuvant treatment for borderline resectable pancreatic cancer (BRPC), no high-level evidence exists to support the role of such treatment.

METHODS:
This phase 2/3 multicenter randomized controlled trial was designed to enroll 110 patients with BRPC who were randomly assigned to gemcitabine-based neoadjuvant chemoradiation treatment (54 Gray external beam radiation) followed by surgery or upfront surgery followed by chemoradiation treatment from four large-volume centers in Korea. The primary endpoint was the 2-year survival rate (2-YSR). Interim analysis was planned at the time of 50% case enrollment.

RESULTS:
After excluding the patients who withdrew consent (n = 8) from the 58 enrolled patients, 27 patients were allocated to neoadjuvant treatment and 23 to upfront surgery groups. The overall 2-YSR was 34.0% with a median survival of 16 months. In the intention-to-treat analysis, the 2-YSR and median survival were significantly better in the neoadjuvant chemoradiation than the upfront surgery group [40.7%, 21 months vs 26.1%, 12 months, hazard ratio 1.495 (95% confidence interval 0.66-3.36), P = 0.028]. R0 resection rate was also significantly higher in the neoadjuvant chemoradiation group than upfront surgery (n = 14, 51.8% vs n = 6, 26.1%, P = 0.004). The safety monitoring committee decided on early termination of the study on the basis of the statistical significance of neoadjuvant treatment efficacy.

CONCLUSION:
This is the first prospective randomized controlled trial on the oncological benefits of neoadjuvant treatment in BRPC. Compared to upfront surgery, neoadjuvant chemoradiation provides oncological benefits in patients with BRPC.

Author information

Jang JY1, Han Y1, Lee H1, Kim SW1, Kwon W1, Lee KH2, Oh DY2, Chie EK3, Lee JM4, Heo JS5, Park JO6, Lim DH7, Kim SH8, Park SJ9, Lee WJ9, Koh YH9, Park JS10, Yoon DS10, Lee IJ11, Choi SH5.
1
Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
2
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
3
Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea.
4
Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.
5
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
6
Department of Internal Medicine Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
7
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
8
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
9
Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
10
Department of Surgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
11
Department of Radiation Oncology, Yonsei University Health System, Seoul, Republic of Korea.