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Neoadjuvant Gemcitabine Chemotherapy followed by Concurrent IMRT Simultaneous Boost Achieves High R0 Resection in

Xiaolun Huang1, Jeanna L Knoble2, Ming Zeng3

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Neoadjuvant chemotherapy with intensity-modulated radiation therapy (IMRT) simultaneous integrated boost (SIB) is feasible for borderline resectable pancreatic cancer (BRPC). This approach significantly improves R0 resection rates, offering a viable treatment option for BRPC patients.

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Surgical Oncology

Background:

  • Borderline resectable pancreatic cancer (BRPC) presents challenges for curative-intent surgery.
  • Downstaging BRPC to achieve R0 resection is a critical goal in treatment planning.

Purpose of the Study:

  • To evaluate the feasibility of an intensity-modulated radiation therapy (IMRT) simultaneous integrated boost (SIB) dose escalation approach for downstaging BRPC.
  • To improve the R0 resection rate in patients with borderline resectable pancreatic cancer.

Main Methods:

  • Retrospective review of 7 years of neoadjuvant therapy for BRPC.
  • Gemcitabine induction chemotherapy followed by concurrent chemoradiation (5-FU and IMRT-SIB) with dose escalation to 5600 Gy.
  • SIB targeted PET-positive areas; restaging imaging performed before resection.

Main Results:

  • 23 out of 25 patients (92%) without distant metastases underwent pancreatectomy.
  • 22 out of 23 resected patients (95%) achieved R0 (negative margin) resection.
  • Gastrointestinal toxicity > grade 2 occurred in 8% of patients; no grade 4 toxicity was observed.

Conclusions:

  • Neoadjuvant Gemcitabine chemotherapy followed by 5-FU-based IMRT-SIB is a feasible strategy for BRPC.
  • This approach enhances the likelihood of achieving R0 resection in BRPC.
  • The treatment protocol demonstrates an acceptable toxicity profile, sparing organs at risk.